By: Martin Johnston

Public hospitals are reviewing their preparations for mass-casualty events in light of the Christchurch massacre.

Forty-nine people were shot dead at two mosques, while another later died of gunshot wounds after being transported to Christchurch Hospital.

Forty-eight survivors were treated at the hospital. Others were treated in community health facilities.

In the space of a few hours on March 15, Christchurch Hospital had to deal with nearly three times as many gunshot survivors as Auckland’s Middlemore Hospital sees on average in a year.

Ministry of Health deputy director-general Deborah Woodley said the Canterbury District Health Board would conduct a formal review of its response to the shootings.

“[It would] provide recommendations to the ministry and other DHBs about the steps the ministry and DHBs can take to ensure the sector is well prepared and able to respond to a similar incident regardless of where it happens in the country.”

Dr John Bonning, a physician at Waikato Hospital emergency department and the president-elect of the Australasian College of Emergency Medicine, said he had gone to Christchurch to speak to staff involved there and support them in the aftermath of the terror attack.

“We have a mass casualty plan in every ED but we will be looking to tweak and revise ours in the Waikato to account for this sort of event. But also for other mass casualty events [such as] the collapse of a stand at a sporting event, a bus crash, an explosion.”

Managing gunshot wounds was part of both basic and ongoing training for emergency physicians.

“We do simulation exercises and discuss all trauma – blunt trauma is way more common of course, but we also practise for penetrating [trauma] – guns and knives.”

Auckland’s three DHBs said they anticipated information from Christchurch Hospital would be shared to inform their own planning for emergencies and mass-casualty events.

“Counties Manukau Health is reviewing emergency plans, including our mass casualty plan, in light of the Christchurch shooting,” added Counties Manukau DHB’s general manager of central clinical services, Ian Dodson.

By Tuesday, the Accident Compensation Corporation had received fatal claims on behalf of all of the 50 people who died from the Christchurch mosque attacks as well as 94 injury claims, 53 of which were gunshot wounds.

ACC has received an increasing number of claims for injuries caused by shooting since 2014. In the 12 months to last June there were 269 new claims.

The Injury Prevention Research Unit at the University of Otago recorded from 50 and 61 deaths a year from firearms from 2013 to 2015, the latest year for which the data is published. The number of gunshot injury survivors treated in hospital in each of those three years respectively was 63, 77 and 87.

A 2008 review of patients at Auckland City Hospital with gunshot wounds – there were 56 patients in 12 years – concluded, “gunshot injury is not a common presentation”.

Most of the patients were men. Just over half of the cases resulted from an accident; a quarter were self-inflicted.

Despite the small number of cases, the overall outcomes for patients were “acceptable”, the review found. Early decision-making and prompt surgery were vital.

An author of that article in the NZ Medical Journal, Professor Ian Civil, a surgeon at Auckland City Hospital’s trauma service, said he hadn’t done any further research on the topic.

“I had forgotten I had published that. It’s such an uncommon problem in New Zealand.”

He said there was “always a need for training” and noted an annual course was run that focused on the prioritising and management of patients with gunshot injuries.

“It was fortunate that many of the specialists [in Christchurch] actually involved in this had done this sort of training. I think the result speaks at least in part to that.

“The results … all of the feedback, all of the outcomes that I have heard about imply that the treatment and the triaging – the sorting – of patients was done very well.

“The fact that nobody has died who reached hospital alive, except one patient who was deemed … to have unsurvivable injuries, I think, is a great testament at least to the early management of these patients.

“Because the big thing that patients die from if they don’t have a brain injury – if you get shot in the brain that’s usually the reason you die – but otherwise it’s bleeding. The systems that they used and the treatment and the sorting … were all successful at identifying those patients and making sure that they didn’t die from bleeding.”

Source: NZ Herald


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