Sunday, January 27, 2008

A Grizzly Day by Mike Hardin, MD

Do you ever wonder if all your life’s training was to prepare you for one moment? In retrospect, Saturday, January 19, 2008 seems like that day.

The setting is our 30-bed mission hospital with a two and a half bed E.R., running on generator power since the electricity was out to our section of the country, with one doctor, one resident, one intern and two nurses on duty on a Saturday morning. At 10:15 AM a bus crashes and overturns on the road winding down from the Andes towards the Amazon, about a 25-minute drive from the hospital.

Six are dead on the scene. Bystanders begin loading other victims into pickup trucks, cars and eventually ambulances to be transported down the road to our hospital or up the road to others.

As soon as we realized the number of wounded arriving (eventually 23), we enacted the finely tuned hospital disaster plan: call everyone related to the hospital and then some and ask them to come help. The hospital ambulance trolled through town to find employees and bring them in.

Broken and bloody body after body came through the door and were placed on stretchers or benches in the hallway. It resembled a scene from a war movie. The amount of blood and gravity of the injuries were overwhelming. We made quick triage decisions as we decided one victim was too far gone to save – we stopped resuscitation and pushed the body to the end of the hallway to free up space for others that could be saved. The number of critical patients quickly outnumbered our medical personnel.

Four with severe head injuries were intubated and placed on our three ventilators. Short one ventilator, a patient’s mother-in-law was quickly briefed on how to keep her son-in-law alive by squeezing the ambu bag and ventilating him while we moved on to other patients. She kept it up for two hours before he was transferred.

Victims were labeled with tags with numbers and brief exam findings. Only later were people identified. Some of the injured had to identify their severely wounded or dead relatives for us.

One scene still plays in my head. A 21-year old Korean American girl wandering through the E.R. door with the entire right side of her face from her nose to her ear hanging off, exposing her skull, the skin held up by her right hand. A missionary took her off for treatment.

Everyone came to help. All of the missionary doctors, various spouses -- even the kitchen, janitorial, maintenance and administrative staff of the hospital were all enlisted in some way. Our administrator’s wife found herself shaving and prepping victims’ heads for suturing. Missionaries and staff donated blood that was immediately transfused into patients -- the closest blood bank was unable to process blood due to the power outage.

A call for help to the nearest hospital brought another five Ecuadorian doctors, among them a much needed orthopedist and general surgeon plus two radiology techs to help with the numerous x-rays.

In all, two patients died, six critical head injury patients were transferred for CT evaluation, several underwent major surgery for internal bleeding or extensive suturing and the remainder had lacerations sutured and fractures splinted or casted.

There were numerous heart-wrenching stories. An injured mother with a one-month old baby identifying her dead husband, her four nephews and nieces severely injured as well, their own mother later found dead at another hospital 45 minutes away. Another mother with her severely injured five-year old son at our hospital, her daughter in another hospital and her husband in even another one two hours away undergoing neurosurgery to remove blood clots from his brain. The American girl, severely disfigured, far from home and alone, in such shock she could only worry about her missing backpack that contained all her research data for her graduate thesis.

And there were bright spots. The incredible spirit of teamwork in a gruesome situation, the accidental transfer of anonymous patients (who ended up being related) to the same hospital, gravely injured patients whose lives were saved. I’m proud of a dedicated staff that freely gave their all to help in a horrendous situation.

The following day we airlifted seven more patients (paid for by the local ministry of health, a miracle in itself) to other hospitals for further treatment and discharged the least of the wounded, an 80-year old woman with a small cut on her forehead.

Missionaries contacted the relatives of the American girl, notified the U.S. Embassy, made lodging and transportation arrangements for the family, arranged for her transfer to a Quito hospital and welcomed her there with hospital visits by English-speakers. Another very determined missionary traveled to two separate towns, three different police stations and the regional transportation office in search of the backpack. She even searched the wreckage of the entire bus and found nothing. Eventually, in a locked storeroom in a ministry of transportation office in a town two hours away she found the backpack, still sealed with all the girl’s research data, cash, credit cards and passport. It arrived in Quito today.

I’m not sure how to end except to ask for your prayers for the numerous victims and their grieving families and for a shocked hospital staff that experienced a lot more than they ever bargained for.