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Easter Sunday horror: How NHSL and Negombo Hospital worked with clinical precision
Scenes at NHSL last Sunday (above and below). Pix by Sameera Weerasekera
Two major hospitals worked with clinical precision, at very short notice, in the wake of the Easter Sunday suicide bombings that shook the country.
The call to the National Hospital Sri Lanka (NHSL) came just after 8.45 a.m. on April 21, about the Kochchikade Church and three five-star hotel blasts and into action they went, with all the “key” people of the Disaster Management Committee being informed immediately.
Negombo Hospital Director Dr. Chandraguptha Ranasinghe
“I was in another part of the hospital though it was a Sunday and as soon as the operator informed me that the telephone exchange had got the alert, I put our plan into action,” says the Deputy Director-General (NHSL), Dr. Kumara Wickremasinghe of this 3,500-bed facility.
He was informed of “multiple blasts” and to expect “a large number of casualties” and so the emergency wheels began turning, with him at the helm as the casualties were brought in a rush to the NHSL’s Accident & Orthopaedic Service which is considered the Level 1 Trauma Centre in the country.
“More operating theatres were opened up, additional Intensive Care Units (ICUs) made ready and the neuro-trauma teams brought in,” he says, adding that resources such as sterile linen were reallocated from other parts of the NHSL. Later many outside donations flowed in.
Initially despatching its own ambulances, he called for support from the Colombo South (Kalubowila), Colombo North (Ragama), Castle Street and Lady Ridgeway Hospitals in transferring the dead and injured from the blast site – 20-25 ambulances plying back and forth with sirens screaming and red lights flashing. This was while casualties were also being brought in private vehicles.
Pointing out that within a short time of about one hour, they received 267 people, Dr. Wickremasinghe explains that three weeks before, the NHSL had rehearsed the contingency plan as they usually do quite often.
Deputy Director-General (NHSL), Dr. Kumara Wickremasinghe
He explains how they dealt with this mass of casualties systematically – as soon as a casualty arrived, he/she was tagged with a number, which number would later be on the Bed-Head Ticket (BHT). Thereafter, ‘triaging’ took place to rush the severely injured to a resuscitation room, with the less severely injured (second level) being taken to a different area and those with minor injuries elsewhere.
Those who were already dead were kept in a separate area, checked for lack of signs of life to confirm death and then sent to the mortuary and transferred to the police morgue for inquest.
Of the 267 casualties (including 130 males and 86 females), 206 were admitted to the hospital. Among them were 21 foreigners. The death toll was 51 including 11 foreigners, the Sunday Times learns.
Dr Wickremasinghe says that 75 casualties are still in hospital, of whom 20 are in the ICU and include four children.
While stressing that he hopes that such unfortunate incidents will not take place again, he says that if regrettably they do occur, the NHSL is ready with its Emergency Response Plan.
He is quick extend his appreciation to all the staff – specialists, medical officers, nurses and paramedical and support staff who not only did their duty but also went beyond the call of duty to serve the country and its people in distress.
It was a similar scenario at the Negombo District General Hospital. When the telephone operator informed Director Dr. Chandraguptha Ranasinghe, he had immediately contacted the Police to verify the bomb attack and get an insight into the number and type of casualties. The reply had been “mass casualties”.
Quickly invoking the Disaster Management Plan, the relevant personnel had got into position quickly.
Having six ambulances, Dr. Ranasinghe had requested institutions close by for support, mustering the services of 24 ambulances.
By the time the casualties came in soon after 9 a.m., the ‘Triage Area’ with a Consultant and his team had been in place, assessing them and transferring them to the Primary Care Unit, OT, ICU or wards.
“All the bodies were checked to confirm that there were no life-signs and sent to the temporary mortuary outside the OPD premises and kept for identification,” says Dr. Ranasinghe, explaining that Consultant Judicial Medical Officers (JMOs) were rushed to the blast site to carry out analysis and secure evidence.
He also alerted all nearby institutions such as the Chilaw, Marawila, Gampaha and Ragama Hospitals and the JMO offices of Mannar and Kurunegala as he realized that if there was a large influx of bodies, there could be a delay in their release if there was a shortfall of JMOs.
“I asked the JMOs to come with their teams, dissecting crews and equipment,” says Dr. Ranasinghe who quickly got his staff to set up temporary dissecting rooms in four garages and also a temporary police post as well as a temporary magisterial post.
The postmortems started around 3 p.m. on Sunday, as they had to await the holding of the magisterial inquiry at the blast site. With 11 JMO stations working from 3 p.m. on Sunday to 1 a.m. Monday, 84 bodies had been released.
As a back-up plan, Dr. Ranasinghe had got in touch with the Defence Ministry and the Health Ministry’s Disaster Management Centre to secure two mobile coolers (40-foot and 20-foot respectively) to store the bodies and prevent decomposition in case there was a delay.
However, the JMOs had worked throughout and by 11 a.m. on Monday, the day after the bombing, more bodies had been released.
The next difficult but essential task was to identify the human body parts, says Dr. Ranasinghe, explaining that as soon as the casualties were brought along with other body parts, the hospital took digital photographs. Each photograph was printed to the size of 8”X6” and displayed at the JMO’s Office lobby, for kith and kin to identify their loved ones.
“These are the photos we looked at closely on Tuesday and were able to match all the body parts to the bodies that had been brought in,” he says.
The Negombo Hospital Director appreciates the “great help” extended by many including the respective Medical Superintendents (MSs) and Directors of the hospitals such as Chilaw, Marawila, Gampaha, Ragama and NHSL; Health Ministry officials including Dr. Champika Wickramasinghe and Deputy Director-General (Planning) Dr. Sridharan Sathasivam; regional and provincial health officials and Gampaha District Secretary Sunil Jayalath.
Donations of dry rations, clothes, water, medical equipment and consumables had flowed in from non-governmental organizations and private organizations.
Post-disaster, the Negombo Hospital has held an in-depth debriefing to focus on any deviations from the recommendations and why and what the way forward should be, both immediate and long-term.
Currently, about 15 casualties are at the Negombo Hospital of whom three are in the ICU, but their condition is stable, says Dr. Ranasinghe.
Around 130 casualties had been brought here on Sunday, of which 44 had been transferred to Ragama Hospital and NHSL.
The number of dead brought in had been 101 (61 females and 40 males), having mainly succumbed to ‘mutilation’ and ‘shrapnel’ and ‘head’ injuries.