It is up to the medical community as well as the general population to act responsibly in such trying times.
KARACHI: Bomb blasts have regrettably become a normal part of our everyday life. On a weekly basis, violence and terrorism take the lives of tens, and sometimes hundreds. Whenever such an incident occurs, there is always an initial death toll, followed by an increase, often dramatic, in the number of casualties over the next few hours. There is little that the security agencies can do about this second number, but the medical community and general population can potentially do a lot. The question, of course, is; are we doing enough? First response is defined as the initial response to a trauma situation and often the ‘first responders’ are not trained personnel but rather lay-persons who were on or around the scene of disaster. Their intervention, although necessary, often leads to further damage to the victims because they may mishandle the spine, while carrying the patients to hospital, leading to preventable neck-down paralysis in these victims. Often, because the shifting of victims happens through motorcycles, rickshaws, private cars and not just equipped ambulances, many of these victims die on the road because of the unavailability of oxygen or other life-saving devices, etc. Hospitals accepting these casualties are often taken by surprise and are unable to triage (a medical term for sorting of high versus low priority victims) the victims, leading to clogging of the emergency departments which leads to a further deterioration of the quality of care provided to those who are most critical. Lastly, in a country with possibly one of the highest cases of trauma, we do not as yet have a fully equipped certified Level 1 (the highest level) trauma facility to cope with such disasters, neither in Peshawar nor in Karachi, or anywhere else for that matter.
Measures that can be taken on the part of both the general population and the medical community include learning, as well as spreading, knowledge and skills regarding safe on-site handling of trauma victims. It often takes only one -to two-day workshops to learn simple life-saving skills as is done by the citizens and high-school students of most developed countries. Luckily there are non-profits in Karachi who provide this high quality training for free. Other measures include knowing the emergency numbers that must be called in the case of disaster. There are a surprisingly large number of people, even doctors, who still dial 15, rather than numbers such as 1021, in the hope of calling an ambulance. People should also be aware of the hospitals designated to accept trauma victims, as not all hospitals accept trauma victims due to medico-legal implications. Lastly, bomb blasts or other accidents are not scenes of drama. People should realise the risks as well as inconvenience they cause to trained response teams when they flock to disaster sites in an attempt to catch a glimpse of the action. Commotion and handling of an angry mob becomes an additional burden on both, the emergency doctors as well as response teams.
Although we do have a lack of resources, it is mainly the lack of coordination and incoherence that raises the death toll after the initial injury. It is up to the medical community as well as the general population to act responsibly in such trying times and make the extra effort to prepare themselves for such situations.
Dr Akbar Herekar
Published in The Express Tribune, September 26th, 2013.
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