Terrorist bombings: medical response in a developing country.
OBJECTIVE
To evaluate the process of transport and immediate Emergency Department (ER) management of mass casualties following the recent bomb blasts in Karachi and review in detail the medical response and management of victims undertaken in these two incidents.


METHODS
Eyewitness accounts of the victims, medical personnel and newspaper clippings were used to understand and identify difficulties faced during the rescue process. Data regarding presenting injuries and their outcomes was also collected from all victims presenting to the emergency department at Aga Khan University Hospital.


RESULTS
Seventy nine individuals died and over 250 victims were injured in the two incidents. All victims and dead bodies were shifted to the nearest public sector hospital overwhelming the health care facility. Subsequently all victims were evacuated to private sector hospitals creating similar difficulties. Over half of the victims presenting at the emergency department had minor injuries and did not require admission. Most patients requiring admission needed orthopaedic intervention.


CONCLUSIONS
A comprehensive disaster plan with a centralized command and control system is required for the city of Karachi, involving all stake holders including charity ambulance services, security agencies, and trauma management facilities. Training courses and exercises for health care personnel should also be made mandatory to achieve professional excellence.
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Hasnain
H
Zafar
Ahmed
A
Jawad
M Shahzad
MS
Shamim
Ayaz Ahmed
AA
Memon
Aamir
A
Hameed
M Shahrukh
MS
Effendi
Saeed
S
Qureshi
D001753:Blast Injuries; D054042:Bombs; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005107:Explosions; D006801:Humans; D054527:Mass Casualty Incidents; D010154:Pakistan; D023481:Terrorism; D013997:Time Factors; D014187:Transportation of Patients / Q000592:standards / Q000706:statistics & numerical data*; D014218:Triage