Patients had travelled for days and hundreds of miles from the earthquake zone to Rawalpindi to seek treatment, many being accompanied by relatives and friends on their journey.
Whilst the earthquake zone was devastated, Rawalpindi, as a larger city, had been less affected
The Rawalpindi Eye Hospital made space available that was converted to create a trauma ward and theatre in order to help cope with the large number of casualties.
When MIST arrived at the hospital, the trauma unit was full, housing 72 patients over 12 rooms and 3 corridors.
The first objective was to document all the patients into a database and write a management plan for each case. This database would be invaluable for the following teams to understand the procedures performed for the management of each patient and also an audit of our experience.
Average age of patients was 24 years old (Range 5 months – 80 years old) with 22 patients less than 10 years old.
Subsequent Teams were sent on a two-weekly rotation maintaining continuity of care for the treated patients and managing new cases.
MIST was allocated 3 barn theatres with surgeons operating simultaneously on cases. This proved successful as if any problem arose in a case, the senior surgeon could step in to advise and assist as necessary. The work was tiring but all members pulled together and left the hospital after all the cases were completed, getting a nap when one could.
The majority of cases were infected wounds, open neglected fractures and mal-positioned fractures which needed further intervention. Of the 72 patients, 57 had lower limb injuries, 20% of patients required a combined Ortho-Plastics approach to salvage the limb, 30% had necrotic bone/osteomyelitis requiring debridement.
Other cases however were beyond reconstruction due to infection and the comorbidities of the patients.
This continuous rotation of teams to treat the injured was a novel way of approaching a difficult problem and providing continuity of care.
For further details of our experience please read,
A Rajpura, I Boutros, T Khan, SA Khan. Pakistan earthquake: Experiences of a multidisciplinary surgical team. Prehops Disaster Med; 25 (4): 361-367, 2010.
