Doctors from one of the two hospitals closest to the
Dr. de Ceballos and colleagues are based at the Gregorio Marañón University General Hospital (GMUGH), the largest public hospital in
Eric R. Frykberg, professor of surgery at the University of Florida College of Medicine and the author of a number of articles related to this subject, endorses their findings in his commentary also published in Critical Care. He emphasizes, "preventing as much as possible the arrival of so many noncritical victims to a definitive care hospital by performing triage first at outside sites before allowing them to inundate the hospital."
Of the 312 patients taken to GMUGH, just 91 were hospitalized, 89 of them (28.5 percent) for more than 24 hours. Sixty-two patients had superficial bruises or emotional shock. Forty-one percent of the 243 patients with more severe injuries had suffered perforation of the ear drum, 40 percent had chest injuries, 36 percent had shrapnel wounds. Fractures, first- or second-degree burns, eye lesions, head trauma and abdominal injuries were also common. The pattern of injuries is consistent with other terrorist bombings. One of the unusual aspects of GMUGH's experience was the large number of blast lung injuries (BLI). The 63 percent incidence (17 cases) of BLI seen in GMUGH's critical patients was higher than previously published results, and "probably reflects a bias in triage of many severely wounded patients to our hospital, which was closest to the blasts," say the authors.
Thirty-two victims sent to GMUGH needed 34 surgical procedures on the day of the blast. Twenty-nine casualties (12 percent of the total or 32.5 percent of those hospitalised) were deemed in critical condition, and two died within minutes of arrival. Twenty-seven casualties were admitted to intensive care units, and were assessed with the Injury Severity Score (ISS) and Acute Physiology And Chronic Health Evaluation (APACHE) II scales in the first 24 hours. Three patients later died of their injuries.
GMUGH dealt with this influx of severely injured patients "with virtually no warning" by immediately performing all of the "appropriate procedures," says Frykberg. According to de Ceballos, "Immediate action was taken to cancel all scheduled surgical intervention and 161 hospitalized patients were discharged in less than 2 hours. A number of patients in the intensive care unit and surgical intensive care unit were evacuated to intermediate-care units. The 123 patients under observation at the emergency department (ED) before the blasts occurred were either discharged home when appropriate or transferred to the wards, and only 10 of them remained at the ED at All elective diagnostic procedures were deferred. At the same time, the teaching pavilion, adjacent to the ED, was set as information center for the families, authorities and the media. Triage was performed by senior faculty at the entrance to the ED, and lasted until around "
The authors conclude, "All in all, common sense, diligence in the triage of patients and serenity seemed to prevail after the initial unavoidable chaos and emotional trauma common to these situations. There was in fact an abundance of medical teams, nursing staff, and resources to treat the critically injured, and no critically injured patient had a delay in treatment."
Source: BioMed Central