Challenges of the management of mass casualty: lessons learned from the Jos crisis of 2001

Abstract

BackgroundJos has witnessed a series of civil crises which have generated mass casualties that the Jos University Teaching Hospital has had to respond to from time to time. We review the challenges that we encountered in the management of the victims of the 2001 crisis.MethodologyWe reviewed the findings of our debriefing sessions following the sectarian crisis of September 2001 and identified the challenges and obstacles experienced during these periods.ResultsCommunication was a major challenge, both within and outside the hospital. In the field, there was poor field triage and no prehospital care. Transportation and evacuation was hazardous, for both injured patients and medical personnel. This was worsened by the imposition of a curfew on the city and its environs. In the hospital, supplies such as fluids, emergency drugs, sterile dressings and instruments, splints, and other consumables, blood and food were soon exhausted. Record keeping was erratic. Staff began to show signs of physical and mental exhaustion as well as features of anxiety and stress. Tensions rose between different religious groups in the hospital and an attempt was made by rioters to attack the hospital. Patients suffered poor subsequent care following resuscitation and/or surgery and there was neglect of patients on admission prior to the crisis as well as non trauma medical emergencies.ConclusionMass casualties from disasters that disrupt organized societal mechanisms for days can pose significant challenges to the best of institutional disaster response plans. In the situation that we experienced, our disaster plan was impractical initially because it failed to factor in such a prolongation of both crisis and response. We recommend that institutional disaster response plans should incorporate provisions for the challenges we have enumerated and factor in peculiarities that would emanate from the need for a prolonged response.

Challenges of Hospital Response to the Twin Earthquakes of August 21, 2012, in East Azerbaijan, Iran

“…In the Jos riots, running out of required items and medicines, personnel at risk, and exhaustion of staff were some of the problems identified. 26 Lack of place for the provision of services and the shortage of beds were among the problems in response to the Bam earthquake. 23 In a study by Nekooei Moghaddam et al, 27 logistics was 1 of the 4 main themes.…”

Back to Basics: Mass Casualty Incidents

“…An additional area of concern that has received minimal attention is the effect of a mass disaster on health care providers who are providing care in very stressful situations. Ozoilo and colleagues addressed some of these issues after a mass casualty event in Nigeria. During a disaster event, many providers may work for 24 to 72 hours at a time.…”

“…These individuals may experience feelings of both physical and mental stress as a result of these extended, high‐pressure work situations. Additionally, these providers may fear for their own personal safety and the safety of their family members, and they may worry about the outcome of the crisis that is occurring . Even health care providers who are more accustomed to treating traumatic injuries may become distressed by the horrific injuries they witness.…”

“…Even health care providers who are more accustomed to treating traumatic injuries may become distressed by the horrific injuries they witness. Disaster plans need to include contingencies to manage the acute distress and posttraumatic stress disorder that can occur among health care providers in situations such as these . Emotional support and counseling should be provided as needed for those who are having difficulty handling these traumatic events …”

Abdominal injuries in communal crises: The Jos experience

“…[ 13 ] Plateau State in North-Central Nigeria, particularly Jos, the State Capital, has been engulfed by a protracted civil strife dating back to September 2001. [ 14 15 ] Within the 15 months under review, the city witnessed escalating outbursts of the lingering and unresolved crises that resulted into 3 major mass casualty events with sporadic attacks in-between. The aim of this prospective study was to determine the incidence, demographics, clinical features, spectrum, severity, management, and outcome of care of abdominal trauma from the Jos communal crises during the period under review.…”