The Mass Casualty from the Jos Crisis of 2008: The Pains and Gains of Lessons from the Past

Abstract

Background: Following the mass casualty of September 2001, we experienced challenges due to the prolonged nature of the crisis and disaster response. We subsequently made changes to our response protocol which were soon tested in the mass casualty resulting from the violence of
November 2008 in our city. We present here the management of the mass casualty situation that resulted from that crisis.
Patients and methods: A retrospective analysis of the management of the patients who presented following thecrisis. Data was collected from the Emergency Room, theoperating room records and the crisis register. Informationgathered included patient demographics, cause of injury, mechanism, body part affected, treatment, morbidity and mortality. Data was analyzed using Epi Info statisticalsoftware using simple percentages.
Results: One hundred and three patients presented over 2 days. There were 101 males (98.1%) and 2 females (1.9%) patients. The ages ranged from 11-65 (+ SD 10.23) years. Injury was caused by gunshots in 71 (68.9%) patients and machetes in 23 (22.3%) patients. The most frequently affected body parts were the lower limbs in 36 (35.0%) patients, upper limbs in 29 (28.2%) patients, chest in 18 (17.5%) patients and abdomen in 14 (13.6%) patients.Nineteen (18.4%) patients required formal surgicalprocedures, mainly exploratory laparotomy, 10 (9.7%).Complications were seen in 14 (13.6%) patients, 11 (10.7%) of these were infection related. There were 3 (2.9%) hospital mortalities. All had severe head injuries.
Conclusion: Majority of the injuries were due to gunshots and only one fifth required urgent life saving interventions. From previous experience, effective and continuous IncidentCommand and Mass Casualty Commander positions , andactivation of unit specific protocols within the hospital
ensured a hitch free hospital response and enabled the hospital to return to routine activities within 24hours.