AbstractTerrorist activities have become increasingly and Hyderabad has been often a key witness to such activities. The most recent being on the 21st February 2013, when twin bomb blast rocked the peace fabric in Hyderabad and where 96 victims were injured and 17 killed.
1) To detail the action taken post bomb blast
2) Analyse the demographic profile of the victims,
3) Enumerate the pattern of injuries and disability sustained by the victims and 4)Recommend measures for Mass casualty Emergencies.
Method: Data collected from the primary site of bomb blast and also data received at the Directorate of Medical Education. Case records of patients taken prospectively as well as retrospectively from the hospitals were used.
IntroductionWHO defines disaster as 'any occurance that causes damage, economic destruction, loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area'. A disaster could be natural or man-made hazard. What we witnessed on the 21st of February 2013, at Hyderabad was a man-made disaster – Bomb blast by terrorists.
Andhra Pradesh and in particular Hyderabad has been exposed to terrorist activities for many years. Hyderabad was on the edge after twin blasts which occurred on August 25th 2007 where at least 43 people were killed and more than 70 others were injured as two bombs rocked a crowded outdoor auditorium and a popular eatery (Gokul Chat) in Hyderabad. These blasts occurred at 8:10 pm in the night. Another incident occurred on May 18th 2007, where at least 10 people were killed and more than a dozen injured in blast at 17th century Mecca mosque in Hyderabad. date very few attempts have been made to analyze the medical situations of the victims post bomb blast in India, hence we are attempting to do one. This paper aims to throw light on the action take, the demographic profile of the victims, patterns of injuries sustained by the casualties and the residual disability they are left with and also suggestions for preparedness to tackle such emergencies.
MethodsOn Thursday, 21st February 2013, a terrorist bomb attack was perpetrated in Hyderabad, Andhra Pradesh, which led to a mass injury situation. Twin blasts a few minutes apart shook the entire neighbourhood of Dilsukhnagar area in Hyderabad. The explosions took place between 07:00 and 07:03 PM. This paper is based on the overall information and data collected by the authors and also reported by the Director of Medical education, on the number of victims treated at the different hospitals and primary care facilities at the scene. Data on the patients received at the various hospitals (Both private and Government) treatment taken and their status was taken concurrently and in a few parts obtained retrospectively. Data was analyzed and interpretations made. Out of the 113, casualties, 17 died. Data on the remaining 96 victims forms part of the basis of this report.
ResultsInitial emergency treatment and triage was carried out by emergency medical services (108- EMRI) near the scenes of the blasts. Triage of the disaster victims was done at the bomb blast site and the victims were segregated based on their severity and sent to Osmania General Hospital and other nearby private hospitals. The vast majority of survivors were evacuated by 108 ambulances and many others by private ambulances and vehicles. Most casualties arrived at the hospitals between 7:30 pm and 9:30pm. The average distance of the private hospitals from the bomb blast site was 3 kilometre +/- 0.5 kilometres and Osmania General Hospital was about 6 kilometres away. As suggested by Forensic experts, ammonium nitrate material was used along with sharp metal objects in the bombs. This resulted in multiple injuries, superficial and deep wounds which penetrated the vital internal organs of the body, fractures and head injuries among the victims. These type of injuries cause massive bleeding, shock and collapse and hence some of the victims died on the spot.
The Explosion and the causalities
The explosions resulted in 113 causalities, 12 of who were killed immediately ( deaths at the scene). There were There were 5 subsequent deaths (while resuscitation and in-hospital deaths), which occurred either on the same day or later on, among the 101 victims who were reported to the nearby hospitals, bringing the total death toll to 17 and the overall mortality rate to 15% (17 out of 113) and the ‘critical mortality rate’ to 4.9% (5 out of 101). The 'critical mortality rate' – the death rate among the critically injured survivors – more accurately reflects the magnitude of the disaster and the results of medical management than does the overall mortality rate, and so it should be used when comparing the outcomes from different disasters.5 The number of injured left who took treatment in the hospitals was 96. A number of procedures were performed as part of the initial resuscitation and stabilization of the injured victims upon arrival to the Emergency departments of the hospitals. Some of these procedures included medication (92.7%), fluid administration (68.8%) insertion of nasogastric tube (20.8%), and endo-tracheal intubation (7.3%). Subsequently all other medical measures were taken up. More than 20% of the victims received blood transfusions during their stay at the hospitals, some of them receiving up to 10 units of blood.
Demographics Type of Disability Conclusion: Most of the injuries were due to penetrating metallic sharps contained in the explosives. Males were more affected than females. Timely intervention and good hospital care definitely helps save a number of lives. Still standard guidelines and protocols for managing mass casualty emergencies need to be developed in India.
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- Statement on Disaster and Mass Casualty Management: Committee on Trauma, American College of Surgeons
- J Peral Gutierrez de Ceballos, F Turégano- Fuentes, D Perez-Diaz, M Sanz-Sanchez, C Martin- Llorente,andJE Guerrero-Sanz 11 March 2004: The terrorist bomb explosions in Madrid, Spain – An analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005; 9(1): 104– 111.
The 7 T’s of Management of Mass Casualty Emergency
1. Timely intervention (golden hour) 2. Triage 3. Transportation 4. Treatment Protocols 5. Transfusion and Treatment Supplies 6. Team Leadership and Spirit 7. Training of the Emergency team