As a doctor who has worked at sites of suicide bombings, I have realised that Pakistan is in a far more deplorable state in terms of emergency medical assistance than I had thought. Countless lives can be saved if we improve pre-hospital care in the country.
On February 13, 2017, a suicide bomber targeted a protest in Lahore, killing 13 people and injuring many more. A chilling video made by one of the eye-witnesses seconds after the blast shows bodies strewn across the road. The person recording the video focuses momentarily on a victim lying in a pool of blood with a visible neck wound.
The victim seems to be breathing and you can hear someone shout at the bystanders to help stop the bleeding. Someone does try to get close, but then suddenly everyone runs away from the scene.
We do not know whether the victim survived or not. But if his bleeding was controlled, his chances of survival and recovery would have increased.
In-depth: Six degrees of trauma
It is hard to filter the gut-wrenching and gory images from my mind, but it is imperative to share this example. With basic knowledge and training, we have the potential to help victims of trauma in the future.
As part of the an orthopedic surgery team, my colleagues and I analysed data from trauma victims over the last few years. We published the study in the Journal of Pakistan Medical Association, and also presented it to one of Pakistan's largest public sector Accident and Emergency Units (A&E), the Jinnah Postgraduate Medical Center in Karachi.
The Advanced Trauma Life Support guidelines, developed by the American College of Surgeons, prioritise trauma recognition and prompt resuscitation. But in Pakistan, our most recent data shows that victims of trauma hardly ever receive pre-hospital care during transport.
Many critical injuries that compromise the vital airway passage and shut off oxygen reaching the brain are actually treatable with simple to complex manoeuvres that should be attempted during transport of these victims to prevent death and disability. Lack of oxygen results in permanent loss of brain cell activity in as much as five to six minutes.
A few years ago, a young man, Sarfaraz Shah, was shot by a member of the paramilitary force in Karachi. The chilling video shows the victim awake, alert and sitting uncomfortably holding his injured thigh.
The haemorrhage, which was most likely from his femoral artery, eventually killed him. His death could have been prevented had some pressure been applied or a tourniquet tied to stop the bleeding before transferring him to the hospital.
In 2014, our group published an academic paper on the pattern of injuries sustained by police commandos attacked by an improvised explosive device in Razzakabad, Karachi.
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The most concerning details of the attack was the time taken for the first casualty to get medical attention. It was 35 minutes.
A victim of polytrauma due to road traffic accident, bomb blast or fall, has been shown by data to have what is called the 'golden hour' during which early detection and prompt resuscitation prevents death.
In the tragic event that took place at the Shah Noorani shrine last year, victims suffered for hours without medical assistance as there are no functioning hospitals in the area. Many victims must have succumbed to their injuries, some of which were treatable had they been attended to by trained paramedics or aware citizens who can play the role of first responders in such events.
Karachi, a city of over 20 million people, has no universal emergency number that citizens can dial for help. In the United States and other developed countries, a universal number like 911 routes all emergency calls to the Emergency Dispatch Operator. This operator stays on the phone and asks a series of questions (6 Ws: Who, What, Where, When, Why and Weapon) and activates the appropriate emergency response while staying on the phone and guiding the victim.
We have a number of ambulance networks with their individual emergency helplines but unfortunately, most of these ambulances are ill-equipped with medically untrained personnel.
Having responded to a suicide bombing in Karachi in 2010, I have personally witnessed the chaos that takes place at the site of disaster. Victims do not get medical attention at the site. Instead of resuscitating the victims on the spot, there are fights and scuffles as to which ambulance network will take the casualty to the hospital.
A collective approach needs to be taken by the government, who has the largest resources, authority and platform to bring all the charity-run organisations under one roof with a single emergency number accessible through phone, radio or internet.
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The research we conducted showed more than twice the level of mortality in mass casualty events in Karachi as compared to the 7/7 bombings in London and the Madrid train bombings of 2004. A team of 14 British Medical Association doctors responded to the London bombings and saved many lives by intervening on site.
In the recent shootings in Quebec, swift response from doctors meant victims with serious injuries were in surgery inside 45 minutes, which prevented the death toll from rising above six.
The overall mortality in the London bombings was 7.2% compared to the 18.6% at the Police bus bombing in Razzakabad. This underlies the importance of on-site and in-transport trauma management and resuscitation, especially when the trauma centre is located several minutes away.
We have a habit of not preparing, mitigating and planning for disasters and their aftermath. We rarely conduct debriefings sessions and gather feedback to alter our response plans.
Although there are some organisations that have trained paramedics who respond to disasters, the country’s health care policy has neglected the importance of paramedics in the trauma-response system.
On the same topic: Need for effective emergency response again highlighted
At the First Response Initiative of Pakistan, we believe that training the general population in basic trauma care and life support can significantly reduce morbidity and mortality caused by trauma.
Training people in simple manoeuvres like applying pressure to bleeding wounds and using a tourniquet in severely injured or amputated limbs, which are common in blast injuries, can save lives before emergency medical help arrives.
All that is needed is government support and intervention.
Have you or someone you know suffered at the site of a disaster or bomb blast due to the negligence of pre-hospital care? Share it with us at blog@dawn.com