A. B. Saeed2, F. G. Qureshi1 1UT Southwestern Medical Center,Division Of Pediatric Surgery,Dallas, TX, USA 2Services Institute Of Medical Sciences,General Surgery,Lahore, PUNJAB, Pakistan
Introduction:
Surgical training in low income countries like Pakistan provide opportunities for an extensive patient care experience within a challenging security environment such as terrorist bombings. Trainees are affected by the event and are also part of the response. This is the experience of senior surgical trainees in Pakistan.
Methods:
Services Hospital is an 1160 bed teaching hospital in Lahore, Pakistan and is a receiving center for victims of terrorism. Four surgical chief residents graduate from the program each year. Six surgical, and two orthopedic residents and one junior faculty are on call for emergencies. We evaluated the response our teaching hospital to terrorist events over the last 5 years (2011-2016).
Results:
There have been three suicide bombings in the last three years with 687 victims; mortality on scene was 152 (22%), 372 patients were transported from the scene, quickly overwhelming our center, and hospital mortality was 76 (20%). Procedures were three chest tubes, 11 laparotomies, two neck explorations and 40 orthopedic cases. No electronic medical record existsed and patient records were not maintained by a dedicated health information management office. All notes were documented by hand, injuries and outcomes recorded. Although triage efforts improved over each successive event, information flow from the triage area to the operating room and to concerned family members was often inadequate. Resuscitation efforts were hampered by lack of staff, equipment, training and communication. Long term outcome data was not available after each event and there was no psychological assessment of either patients or providers.
Conclusion:
Terrorist events unduly impact our ability to train, learn, educate and provide clinical care. Concerns about our personal safety, our families’ safety and safe transport to the hospital during crisis remain. As such, events continue to occur, access to dedicated trauma fellowships and courses such as Advanced Cardiovascular Life Support (ACLS), Advanced Trauma Life Support (ACLS), and Advanced Trauma Operative Management (ATOM) will improve care provided. We will need administrative support to develop better staff and family communication tools, database management and mechanisms to ensure our safety. Support for our trainees to identify PTSD will be critical. Partnerships with trauma centers across the globe will improve the learning environment and care to the trauma victims of terrorism.