J. Kincaid1,3, G. Mulima3, N. Rodriguez-Ormaza2, A. Charles2, R. Maine2 1Thomas Jefferson University,Surgery,Philadelphia, PA, USA 2University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA 3Kamuzu Central Hospital,Surgery,Lilongwe, Malawi
Introduction: There is a dearth of information regarding mass-casualty incidents (MCIs) in low resource settings like Malawi. Most literature describes single catastrophic events that expose the fragility of a trauma system and its limited ability to handle the sudden increase in patients. However, in low resource environments, events that can stress the hospital care delivery system are more common than large disasters. We aim to describe the frequency and characteristics of mass casualty events at a tertiary hospital in Malawi.
Methods: We retrospectively analyzed trauma registry data at a tertiary hospital in Malawi from January 1, 2012 through December 31, 2016. We defined MCI as ≥4 trauma patients presenting simultaneously. We present descriptive statistics and a bivariate analysis comparing patient, trauma mechanism, and outcome characteristics for MCI and non-MCI trauma patients. Categorical variables were compared with chi-squared or Fisher’s exact test and continuous variables were compared using the t-test or the Wilcoxon rank sum test. Statistical significance was defined as p?0.05.
Results: From 2012 to 2016, 75,278 trauma patients arrived at the casualty department; 2,227 patients (3%) arrived as part of an MCI. A total of 341 occurred during five years, an average of 1.1 per week. Most MCIs involved between 4 and 6 people. More women were part of an MCI, 35% vs. 27% for non-MCI. MCI victims were older than non-MCI patients (29±15 vs. 23±14 years). The most common mode of transportation overall was private vehicles for both MCI (52%) and non-MCI (35%) respectively. The median time to hospital presentation is shorter for MCI patients (1hr vs. 4hrs, p<0.0001). More of the MCI patients presented between 6pm and 6am (41% vs. 25%, p<0.0001), when staffing at the hospital is the lowest. Vehicle-related trauma was the most common mechanism for MCI, 77%, compared to 25% for non-MCI (p<0.0001). MCI patients were also admitted to the hospital more frequently (20% vs. 16%). A higher proportion of MCI victims were brought in dead (3% vs. 1%, p<0.0001). While overall mortality was higher among MCI victims (4% vs. 2%, p<0.0001), in-hospital mortality was 5.6% for both MCI and non-MCI patients.
Conclusion: In Malawi, MCIs occur frequently, and most MCIs arrive between 6pm and 6am when staffing is most limited. Hospital and public health efforts should address staff capacity for MCIs and efforts to decrease road traffic crashes. While overall mortality is higher in MCI, MCI patients who arrive at the hospital alive, have an equal chance of survival to discharge rate as admitted non-MCI patients. Establishing pre-hospital care and an organized trauma system to improve triage could improve post MCI survival.