About 1900 in a place called Kisii, close to Kisumu on Lake
Victoria, an over laden bus full of about 70 teenagers attending a sporting
event had crashed at high speed. There were about 8 dead at the scene including
the teachers and 10 or so critically injured and the other 50 with an
assortment of walking wounded. The local population had mobilised and were
dragging the casualties to the local hospitals including to the larger nearby
town of Kisumu. The pictures and footage at the scene depict what you would
expect: people running about haphazardly carrying people in bedsheets, rushing
off with them in the back of pick ups and taxis, a couple of local policemen
completely overwhelmed and no sign of a fire service or any ambulances. Mass
casualty disasters like that must be terrifying, especially if you know that no
help is coming. When you know there will be no flashing lights, no big boys in
uniform telling you what to do and no one to assess and triage the injured. As I
slept peacefully, Kisii had turned to complete chaos.
The local hospitals did their best but the majority of the
critically injured succumbed to their injuries overnight. With current advances
in trauma care I can reasonably claim that most of the critical initial
survivors would not had died if there was an early, coordinated Emergency
Medical Service, Fire and Police response taking them to a well-resourced major
trauma centre. In the same week there has been two similarly horrific events
occur in the first world – a train crash in France and an oil tanker explosion
in Canada. I have watched those stories unfold on the BBC World News, CNN and
Al Jezeera. I bet you didn’t even know
about this tragic loss of life in Kenya though, despite it being officially
declared a ‘national disaster’ by the Government or the fact that there was a
worse crash back in February killing 35. The tragic thing is that Kenya has
enthusiastic people with the skills and the resources to provide a better
response. This is the kind of horror story that my new friends at KCEMT (the Kenyan
Council of Emergency Medical Technicians), the CDC and John Hopkins University
are working so hard to make a thing of the past.
This should be the part of the story in which I explain how
we were mobilised and ready at first light with two planes fully equipped to go
and stabilise and retrieve the most critical from the disaster. Unfortunately
we had no idea of the scale of the tragedy that morning and I was sent off
early to Kismayo to pick up a load of injured but stable soldiers. It was only
as we were setting off back to Nairobi that we learned that the regional
governor for Kisii had informed the Government’s ‘disaster control centre’. The
reason for the delay is unclear. Then this plea for help was escalated to the
President himself who officially declared it a disaster.
It still took a while
for AMREF FD to be authorised to send a caravan plane out to Kisii, along with
a few police helicopters and bring the patients back to Nairobi. Kenya’s Red
Cross ambulance service were also heavily involved but they could not cope with
the situation on their own. They are a paramedic staffed ambulance provider and
are simply not geared up for the safe transfer of severely injured patients.
AMREF FD is the only certified air ambulance in East Africa that can do the
kind of highly skilled rapid triage, treatment and evacuation of the most
critical casualties. I hope that the Kenyan people are starting to recognise
this. I do hope that the government can now understand that AMREF FD is a
specialist resource that can be used to save lives if they are allowed to be
involved early enough.
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| The Caravan Plane used in the evacuation |
Personally I found all this out after we had handed over our
soldiers in Nairobi and one of our caravans had already headed out for Kisii.
Frustrated I had missed the action, I was put on standby in case they needed
another team. Our guys had already made it the hospital to find that ‘most of
the local population seemed to have taken up residence in the hospital’. People
from all over the region rushed there after the accident to look after their
relatives or probably just to have a good look at the tragic story. The
ambulance was unable to even get to the entrance of the hospital because the
main road had become a car park with empty vehicles. Then inside the hospital
there was barely room to assess and transfer the patients along the corridors,
it was so packed with people. It was a perfect example of why the police are so
vital to control the crowds and ensure access and egress from the scenes of
major incidents. In the end they managed to get in and triage the 53 patients
concluding that only 4 needed to be airlifted to Nairobi. The rest could be
safely treated where they were.
As we waited at Wilson by our hanger it became busier and busier. Soon there was a massive crowd of news media, the Red Cross chaps, members of parliament and the Kenyan police. I thought it was a rather big turnout for just four patients. Then someone explained to me that nearly 20 injured patients were being airlifted because the President had declared a disaster. Therefore all the injured must come to the Government hospital in Nairobi.
As the cameras clicked away Charles and I took the first
multi trauma case (head and chest injuries) to Kenyatta hospital. I had never
been there before and we greeted by even more media. We were soon joined by
more and more ambulances dropping off their patients and the already stretched
A+E was suddenly swamped. Our staff and the Red Cross paramedics were impressed
by how many staff had been diverted to come and take their patients. It’s true,
we did not need to hang around. The patients from the incident were all seen
very quickly. But I saw how busy the A+E Department was before we arrived and I
wonder how the other patients fared while this influx inundated the hospital.
As I returned to Wilson airport, we were asked to head
straight out to Kisumu (not far from Kisii) where one of the young girls
involved in the crash had been taken. Strangely, we were stood down at the last
minute. Apparently new arrangements had been made. I was surprised and assumed
that she must have passed away. I was even more surprised when, the next day,
Kizito and I were instructed to retrieve the poor girl again. What had happened
became clear when we arrived. We were told by the staff at Kisumu that a police
helicopter had turned up instead of AMREF FD with just a mattress in the back
and no medical personnel. Thankfully the medical staff at Kisumu stood their
ground and refused to allow such a critically ill young girl to get airlifted
like that. Again I have to emphasise that when there is a resource like AMREF
FD, capable of stabilising and safely transporting such a patient, sitting on
your doorstep, ready to go at a moment’s notice, then it must be used.
Unfortunately another 24 hours had been wasted.
By the time we were at her
bedside, her conscious level had deteriorated further. She was now only responding to painful stimuli by inwardly twisting and extending her arms,
which is a sign of quite considerable neurological impairment. She was certainly
not protecting her own airway so, yet again, Kisito and I set to intubating,
sedating and ventilating her and trying to protect her brain as best we could.
I think we were reasonably successful as the high spikes in pulse, respiratory
rate and blood pressure she was having on the ward, settled with us and she was
nice and easy to manage on transfer.
Upon arrival we were met by the CEO of Kenyatta hospital who
was extremely grateful for the safe transfer. I think that he clearly
understands that now, when the police or Nairobi’s ambulance services can’t
handle it, he knows who to call.
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