title: Mass casualty management after a suicidal terrorist attack on a religious procession in Quetta, Pakistan.
abstract: OBJECTIVE
  To determine the effectiveness of hospital management, considering triage system, hospital staff response, medical resources availability, and surgical management depending upon the nature and pattern of injuries in a mass casualty incident.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Combined Military Hospital, Quetta, Pakistan in March 2004.
  
  
  METHODS
  All injured by gunshot or blast in a terrorist attack and reported to the hospital were included in this study. Patients were triaged by the triage team using "triage sieve" into priority I, II, III, and IV. Priority I patients were further triaged by using "trauma index" to prioritize for surgery. Phase I included life saving, Phase II limb saving surgery and Phase III for debridement. All data was recorded and analyzed.
  
  
  RESULTS
  Hospital received 161 casualties among whom 20 were brought in dead, and 141 patients were admitted to the hospital. Mean age was 26.63 +/- 13.97. The cases were categorized as Priority-I 22.7%, Priority-II 14.72%, Priority-III 50.31% and Priority-IV 12.27%. Maximum casualties reached within the first 2 hours. Eighty-eight patients had pre-dominantly splinter injuries and 53 patients had dominantly gunshot wound injuries. In priority I, the trauma index was 15.55 +/- 5.74. Six patients having trauma index 20 or above could not even be resuscitated. Seventy five percent of staff reported to the hospital within 15 minutes. Only 30% of reserve medical store was consumed. Total management cost to the hospital was Rs. 362,1856/- (British Pounds approx 32,052/-.) calculated by the hospital rates for treatment of non-entitled patients. Death rate in hospital survivors was 4%.
  
  
  CONCLUSIONS
  Mass casualty management in a terrorist act requires prompt hospital response, appropriate triage, efficient surgical approach, and dedicated postoperative care. A good response can help to decrease mortality rate in salvageable injuries.
authors.affiliation: Department of Orthopaedics, Combined Military Hospital, Quetta. Zakamalik2003@yahoo.com
authors.forename: Zaka Ullah
authors.initials: ZU
authors.lastname: Malik
authors.forename: Muhanmmad Shoaib
authors.initials: MS
authors.lastname: Hanif
authors.forename: Muhammad
authors.initials: M
authors.lastname: Tariq
authors.forename: Rizwan
authors.initials: R
authors.lastname: Aslam
authors.forename: Aslan Javid
authors.initials: AJ
authors.lastname: Munir
authors.forename: Hashim
authors.initials: H
authors.lastname: Zaidi
authors.forename: Muhammad
authors.initials: M
authors.lastname: Akmal
mesh_terms: D001753:Blast Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003906:Developing Countries; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000639:trends; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000639:trends; D005107:Explosions; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010154:Pakistan; D012067:Religion; D018635:Rescue Work / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate; D023481:Terrorism; D014218:Triage