title: Mass-casualty Response to the Kiss Nightclub in Santa Maria, Brazil.
abstract: On January 27, 2013, a fire at the Kiss Nightclub in Santa Maria, Brazil led to a mass-casualty incident affecting hundreds of college students. A total of 234 people died on scene, 145 were hospitalized, and another 623 people received treatment throughout the first week following the incident.1 Eight of the hospitalized people later died.1 The Military Police were the first on scene, followed by the state fire department, and then the municipal Mobile Prehospital Assistance (SAMU) ambulances. The number of victims was not communicated clearly to the various units arriving on scene, leading to insufficient rescue personnel and equipment. Incident command was established on scene, but the rescuers and police were still unable to control the chaos of multiple bystanders attempting to assist in the rescue efforts. The Municipal Sports Center (CDM) was designated as the location for dead bodies, where victim identification and communication with families occurred, as well as forensic evaluation, which determined the primary cause of death to be asphyxia. A command center was established at the Hospital de Caridade Astrogildo de Azevedo (HCAA) in Santa Maria to direct where patients should be admitted, recruit staff, and procure additional supplies, as needed. The victims suffered primarily from smoke inhalation and many required endotracheal intubation and mechanical ventilation. There was a shortage of ventilators; therefore, some had to be borrowed from local hospitals, neighboring cities, and distant areas in the state. A total of 54 patients1 were transferred to hospitals in the capital city of Porto Alegre (Brazil). The main issues with the response to the fire were scene control and communication. Areas for improvement were identified, namely the establishment of a disaster-response plan, as well as regularly scheduled training in disaster preparedness/response. These activities are the first steps to improving mass-casualty responses.
authors.affiliation: 1City of Porto Alegre Emergency Department,Porto Alegre,Brazil.
authors.forename: Silvana T
authors.initials: ST
authors.lastname: Dal Ponte
authors.affiliation: 3Hospital de Pronto Socorro,Porto Alegre,Brazil.
authors.forename: Carlos F D
authors.initials: CF
authors.lastname: Dornelles
authors.affiliation: 4Department of Emergency Medicine,SUNY Downstate Medical Center,Brooklyn,New YorkUSA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Arquilla
authors.affiliation: 4Department of Emergency Medicine,SUNY Downstate Medical Center,Brooklyn,New YorkUSA.
authors.forename: Christina
authors.initials: C
authors.lastname: Bloem
authors.affiliation: 4Department of Emergency Medicine,SUNY Downstate Medical Center,Brooklyn,New YorkUSA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Roblin
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002249:Carbon Monoxide Poisoning / Q000401:mortality* / Q000628:therapy*; D004189:Disaster Planning; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005390:Fires; D006801:Humans; D006856:Hydrogen Cyanide / Q000506:poisoning*; D008297:Male; D054527:Mass Casualty Incidents; D011998:Recreation; D015208:Smoke Inhalation Injury / Q000401:mortality* / Q000628:therapy*; D014218:Triage
chemical_list: D006856:Hydrogen Cyanide
keywords: CDM Municipal Sports Center; HCAA Hospital de Caridade Astrogildo de Azevedo; HUSM Hospital Universitário de Santa Maria; ICU intensive care units; SAMU Mobile Prehospital Assistance; response