title: Impact of a predefined hospital mass casualty response plan in a limited resource setting with no pre-hospital care system.
abstract: BACKGROUND
  Pre-hospital triage is an intricate part of any mass casualty response system. However, in settings where no such system exists, it is not known if hospital-based disaster response efforts are beneficial. This study describes in-hospital disaster response management and patient outcomes following a mass casualty event (MCE) involving 200 victims in a lower-middle income country in South Asia.
  
  
  METHODS
  We performed a single-center, retrospective review of bombing victims presenting to a trauma center in the spring of 2013, after a high energy car bomb leveled a residential building. Descriptive analysis was utilized to present demographic variables and physical injuries.
  
  
  RESULTS
  A disaster plan was devised based on the canons of North-American trauma care; some adaptations to the local environment were incorporated. Relevant medical and surgical specialties were mobilized to the ED awaiting a massive influx of patients. ED waiting room served as the triage area. Operating rooms, ICU and blood bank were alerted. Seventy patients presented to the ED. Most victims (88%) were brought directly without prehospital triage or resuscitation. Four were pronounced dead on arrival. The mean age of victims was 27 (±14) years with a male preponderance (78%). Penetrating shrapnel injury was the most common mechanism of injury (71%). Most had a systolic blood pressure (SBP) >90 with a mean of 120.3 (±14.8). Mean pulse was 90.2 (±21.6) and most patients had full GCS. Extremities were the most common body region involved (64%) with orthopedics service being consulted most frequently. Surgery was performed on 36 patients, including 4 damage control surgeries. All patients survived.
  
  
  CONCLUSIONS
  This overwhelming single mass-casualty incident was met with a swift multidisciplinary response. In countries with no prehospital triage system, implementing a pre-existing disaster plan with pre-defined interdisciplinary responsibilities can streamline in-hospital management of casualties.
authors.affiliation: Aga Khan University-Johns Hopkins University Outcomes Research Collaboration, Karachi, Pakistan. Electronic address: adl_ajz@yahoo.com.
authors.forename: Adil Aijaz
authors.initials: AA
authors.lastname: Shah
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Abdul
authors.initials: A
authors.lastname: Rehman
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Raza Hasnain
authors.initials: RH
authors.lastname: Sayyed
authors.affiliation: Center for Surgical Trials and Outcomes Research (CSTOR), Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Adil Hussain
authors.initials: AH
authors.lastname: Haider
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Amber
authors.initials: A
authors.lastname: Bawa
authors.affiliation: Aga Khan University-Johns Hopkins University Outcomes Research Collaboration, Karachi, Pakistan.
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.lastname: Zia-Ur-Rehman
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Kamran
authors.initials: K
authors.lastname: Ali
authors.affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000401:mortality / Q000628:therapy*; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005107:Explosions; D005260:Female; D006801:Humans; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D023481:Terrorism; D014187:Transportation of Patients / Q000458:organization & administration* / Q000706:statistics & numerical data; D014218:Triage / Q000458:organization & administration*
keywords: Developing country; Disaster plan; Disaster response; Low-middle income country; Mass casualty event; Resource limited; Terrorism; Trauma