ER

Twice now, we’ve gotten huge numbers of injured people from vehicle accidents. Things are difficult in a hospital made of poles and plastic sheeting in the best of times, but with an influx of 15 to 20 injured people at night, it can get ugly fast. Luckily Emir (our doctor) is really good at handling situations like that. The team works together really well, and we all know our specialties well and how to anticipate problems, so it’s exciting, but not utter pandemonium,

The first one came a few weeks ago with no warning. The Physician Assistant on duty at the hospital called on the radio around 9 or 10 pm as we were all getting ready for bed. He said he had 14 newly arrived cases at the Emergency Room and that there was another car coming. The accident that injured all these people was due to a big truck running off a bridge and plunging into a creek. We never really got a credible report of what happened, but the rumor going around was that 7 people were known to be dead at the accident scene, and that 4 more bodies were pulled out of the creek in the morning. When Emir got the call, I went to Lilian’s room and told her Emir would probably want her help. Then I went to get on the radio and talk with the camp guards. Our hand-held radios are at their limit of reception, so it helps a lot to have an operator at the main radio at base who can relay messages. Because the radio room is next to the Field Coordinator’s room, she also got up. So the medical people gathered up supplies like extra gauze, gloves, and tetnus vaccine and headed out. Emir used the big open space of the outpatient clinic waiting room as a triage area, and then moved patients through our single ER one at a time. There are electric lights in the ER, but not in the triage area, so I imagine there was a fair amount of scrambling for flashlights and batteries. One great decision Emir made was to have me immediately get a taxi waiting at the hospital. After his initial assessment, he loaded the taxi with the worst cases who needed the least stabilization and sent them to Ganta. So within 15 minutes, he’s already gone from 14 patients to 11. We ended up sending a second taxi that night with more patients.

Last night around 5:30 pm, we got a call that an accident had injured 30 people nearby and we were asked to go pick up the patients. We don’t run an ambulance service, so we have to say no to those requests. But sometimes there are extenuating circumstances, so we keep our mind open. Getting one call about 30 injured people jolts you to attention, but also makes you ask, “is that real information, or a rumor?” So you start asking around, emphasizing that what you heard in unconfirmed, etc. Due to turnover on both sides, we don’t have really great contact info for UNMIL and Civpol (the UN-operated civilian police service). We did find a number for a Merci person in Nimba. They have an ambulance that sometimes drops patients at our hospital, so I asked them to go see what was going on beyond Bahn where the accident reportedly was. I was also
tracing the progress of one of our vehicle home from Lepula, and I realized too late to warn them that they would be passing the accident site. Luckily, they found the injured people and poor Jerome (outreach/bush nurse) found himself in the middle of about 200 Liberians freaking out and all wanting a ride to Saclepea on the MSF car. He assessed the patients and chose the 2 that he could take. Unfortunately, by the time Jerome was on the scene and could give us accurate information that would have allowed us to send a car to help him, it was too late to send a car because they don’t drive outside of Saclepea at
night. So Jerome did the best he could with the space he had.

At base, we scurried around gathering supplies. It was clear that we learned a lot from last time by how well organized people were. I realized I had all the stuff I needed easily available to make a lighting system in the triage area, so I went along with the medical staff carrying all my lights and cables. I grabbed one of the watchmen and started setting up the lights. They were ready about 30 seconds before Jerome arrived with his patients. Like last time, I arranged to
have a taxi standing by. Everything went smoothly, too smoothly. Of course because we were so well prepared, the 30 patients didn’t really materialize. After Jerome arrived with his two patients, another truck came carrying quite a few more patients. The head PA arrived from town, and had picked up a number of other medical staff he’d seen in central town along the way. There was almost one PA per patient, which made the assessments go fast. The injuries were minor, or at least not the super-dramatic open femur fractures that are the real nightmares.

When we got home, Emir thanked me for the lighting system, and said it made a real difference. I’m now considering how to arrange for the emergency lighting system to be ready to deploy for the future. I think I will add a plug to the electrical system nearby and then stockpile the lights, extension cord, and power strip in a box at the base. I’ll probably put some instructions in it, because the problem is that there’s a chance that by the time I have it ready to use, there will be no more emergencies. The next log will need it someday and have to figure it out on the fly. Hopefully marking it clearly and putting the instructions in will help.