EARLY RESPONSE (Red MiST)
MiST Foundation sent their first team to Rawalpindi, Pakistan in November 2005, 4 weeks after the earthquake. The Rawalpindi eye hospital was a private institution, and part of it had been converted into a trauma hospital to help cope with the large number of casualties.
The team consisted of a specialist Trauma surgeon, a Plastic Surgeon, Anaesthetist, an ODP and Scrub nurse and stayed for 2 weeks. Subsequent Red MiST units were sent on a two-weekly rotation maintaining a continuity of care for the treated patients and managing new cases.
The first objective was to document all the patients into a database and write a management plan for each case. This database proved invaluable for the following teams to understand the procedures performed for the management of each patient and also an audit of our experience.
The patients had arrived in Rawalpindi from the earthquake zone situated hundreds of miles away. Some victims had been evacuated from the disaster zone, others had travelled with relatives to the safety of a large city where medical help was easier to find than in the devastated rural areas.
When the Foundation arrived at the hospital, there were 72 patients housed in 12 rooms (4-6 pts/room) and 3 corridors (4-6 pts).
Average age of patients was 24 years old (Range 5 months – 80 years old) with 22 patients less than 10 years old.
The Foundation was allocated 3 barn theatres with surgeons operating simultaneously on cases. This proved successful as if any problem arose in a case, the senior surgeon could step in to advise and assist as necessary. The work was tiring but all members pulled together and left the hospital after all the cases were completed, getting a nap when one could.
The local institution allocated 6 nurses, 2 junior doctors in addition there were 2 UK wound nurses and 3 Volunteers.
The majority of cases were infected wounds, open neglected fractures and mal positioned fracture which needed further intervention.
Of the 72 patients, 57 had lower limb injuries.
20% of patients required a combined Ortho-Plastics approach to salvage the limb
30% had necrotic bone/osteomyelitis requiring debridement
Other cases however were beyond reconstruction due to infection and the comorbidities of the patients.
Pre-Op Post-Op
Many cases had necrotic bone which required excision and acute shortening of the limb with a combination flap to cover the soft tissue defect.
Team 1 Team 2
This continuous rotation of teams to treat the injured was a novel way of approaching a difficult problem and providing continuity of care.
We hope we achieved our goal of helping as many of the injured as we could and to save them from the inevitable amputation and the social stigma that is associated with such a procedure.
For further details of our experience please read,
A Rajpura, I Boutros, T Khan, SA Khan. Pakistan earthquake: Experiences of a multidisciplinary surgical team. Prehops Disaster Med; 25 (4): 361-367, 2010.
One can download this paper from our RESOURCE-Publications section.