Leaving Glenna to tend to the boy, I tried to locate the hired Medical Officer for the Surgical Casualty Unit, but she could not be found! Next, I tried to find the local Intern rotating in Casualty, but she too could not be found! Taking a quick inventory of our staff, I had Mzungu (white-man) me, three Mzungu medical students from Harvard, one local Mulago medical student, two nurses, and four or five student nurses. In my North American bossy voice I ordered every non-emergent patient and visitor out of the casualty area, including those waiting for x-rays. Most seemed quite shocked at my authoratative voice, but promptly moved for me! It was only minutes before we started receiving the first wave of casualties.
Initially, we had four or five casualties arrive at once and so started the Mass Casualty triage: No pulse - leave 'em dead. Pulse, but weak or not breathing - start bagging and start an IV. Breathing, but weak radial pulse - start an IV. The three medical students were invaluable in assessing and doing the ATLS trauma assessment. All the traumas that they had seen earlier in the week had paid-off! The sickest patient that we treated had profound respiratory distress. He was promptly intubated, but immediately started gurgling blood out of his ETT (intubation tube). We suctioned and sent him to ICU for chest tubes and possible surgery. Apparently, the ICU team (minus Glenna who was in CT with the unconscious boy), worked on him for about 3 hours (the entire time that we assessed the remaining 19 casualties). Unfortunately, he succumb to his internal chest injuries.
Glenna returned within an hour of taking the boy to ICU and helped me and the now present Medical Officer to finish the trauma assessment, radiological review, and dispositioning of the remaining casualties. In total was had received two waves of patients with a trickle of patients after the waves. In total, we estimated that we treated 20 people. 19 lived! That is, they were still alive when we went home 6 hours after the building collapse. Apparently, one other person died at the scene and had not been brought-in to the hospital.
We later found-out that the building was a mall that had construction immediately adjacent to one of its walls. The outer wall of the building had collapsed pulling down one section of the two-storey complex. Interestingly, in reviewing the photos we see that the building wall had collapsed outwards causing the floor to slope down. This would have tossed the people outwards onto the rubble pile as opposed to the building falling-in on top of them. This explained the low number of crush injuries and the minor nature of most injuries to our casualties. Lucky for them - lucky for us!
This was the first time we actually saw the resuscitation room hopping at a fast pace!
Sean reviewing with Rob, a fourth-year Harvard medical student hoping to do Dermatology! (Not taken during mass casualty situation)
Josepine, the Mulago resuscitation nurse bagging a patient.
Sean and Josh, a fourth-year Harvard Medical student with plans to do Radiology. Ever seen a Radiologist with a bag-valve-mask in hand? This guy's good!
Here's (left to right) Josh, Rob, and Michelle resuscitating a patient in the casualty resuscitation room. This was a patient who had been beaten-up by a gang of Boda Boda drivers. Michelle is a fourth-year medical student from Northwestern in Chicago.
Glenna and Josh doing the ATLS protocol - our most practiced protocol at Mulago.
Dr. Martin (icu resident) and one of the paramedical anaesthesists at the bedside of a ventillated patient.
Sean teaching some ATLS to Josh and Michelle.
Glenna at the end of the crazy day of work!
Sean, looking a little tired, a little sweaty, and a little frazzled after the mass casualty.
The aftermath clean-up.
All in a day's work here! We obviously needed to unwind after this day so we took-in the 40,000 Shilling Irish Stew and Guiness at the local Irish Pub called Bubbles O'Leary's! Great name, eh?
The End.
Sean
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