"Mass casualty management (Rana Plaza Tragedy) in secondary military
hospital-anesthesiologist experience: case study"
#MMPMID28265417
Murshed H
; Sultana R
Disaster Mil Med
2015[]; 1
(?): 2
PMID28265417
show ga
Major challenges in the management of mass casualty have been identified as lack
of human resources, lack of material resources, lack of communication and
co-ordination. Our hospital has limited resources of manpower and disposable
items. The Departments of Anaesthesiology and Intensive Care have been seriously
disrupted by the influx of 155 severely injured patients following the collapse
of a nine storey building. Such a large, instantaneous influx of injured citizens
would overwhelm even the most well resourced health care system. A
multidisciplinary team approach was planned to manage the casualties. Senior
anaesthesiologists took responsibility for the organisation of different staff
members into medical triage team, an immediate care team, an urgent care team, a
non-urgent care team and a clerical team. Different teams have accomplished
casualty management by addressing four principal issues (the assessment of
available resources; ensuring critical but limited care; stocking up on medicine
and equipment for the patient surge; and tough rationing of decisions).
Assessments of available resources were done by emphasising three #8216;S's -
staff (human resources), stuff (material resources) and structure. Additional
human resources (anaesthesiologists, orthopaedic surgeons etc.) and material
resources (#8216;H' type oxygen cylinders, intravenous fluid etc.) were
reinforced from nearby hospitals. Additional influxes of critical patients were
supported in the postoperative ward and recovery rooms without any monitoring
devices. A surgical dressing room without any basic monitoring device was used as
an operating room. To do the greatest good for the greatest number of patients,
we restricted ourselves to providing "essential rather than limitless critical
care". "Stocking up on medicine and equipment resources" on assessment of the
constraints in managing the patient surge, was the next essential step in the
management of the casualty load. Patients with life-limiting illnesses were
excluded from receiving scarce critical care resources. Thus "Tough rationing of
decision" was also an important element. Although the patients that were managed
were not large in number, a consideration of the setup with a limited workforce
and modern equipment and management experience of a mass casualty addressing the
four principal issues in our department, might also help other departments in
managing such events.
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