Pre Hospital Trauma

A few months ago this post was destined to be a very short entry. Incredibly short as basically there wasn’t anything to write about. It's a fact that one of the highest causes of death or morbidity in Zambia is road traffic accidents. The infrastructure of the roads, the car conditions and drivers all add up and then when there isn’t any decent medical attention at scene it becomes an enormous problem. Day in day out in the emergency dept, emergency theatre and ICU we see the consequences of these accidents. However never in a million years did I expect to be involved in two of these in 10 days. I’ve already posted some pictures of the overturned bus on the way back from Livingstone but having had to stop for a second (more serious) accident on the way to Mongu I felt I needed to clarify the situation.

A huge overturned truck 

Overturned bus

As we left Lusaka I was shocked to see an actual fire engine on the road. So shocked that I actually took a few pics of it through the window and sent it to a mate who is a firewoman back home! Never did I think (when we overtook them) that we would meet them again an hour later. In fact they were travelling to the very accident at that time. Its amazing that they weren’t in any hurry to get there.

Sitting behind the fire engine on outskirts of Lusaka

Leaving the fire engine behind us ... only to be reunited with it an hour later!

Just outside a village before the Kafue National Park (and about 15 mins from a police roadblock) we get to an baffling scene. The road was full of people gathered in a huge crowd around what I could see was upturned wheels. It was like watching ants stream towards a sugar pot. We pulled up and Wisdom and I had to try and push our way to the front to find out what was happening but meanwhile we saw people getting loaded into an ambulance so went there first to investigate.

Completely overturned lorry with people milling around everywhere on the road

The large load of timber had destabilised the overtaking

Front of the cab with people trapped inside

What had happened was a lorry carrying a huge load of logs was overtaking another lorry when the trailer somehow clipped the back of the other lorry as the road was a bit narrow, it lost control and flipped over. That was bad enough but then I learnt there were 10 people in the cab. TEN! This included a woman and baby. They’d just come through the police roadblock check with no problems. It makes me furious that this is allowed. There was no way there could have been safety belts applied with this much overcrowding. As we got there they were dispatching the last of the walking wounded (6 in total and thankfully included the mother and child) into the ambulance. I loosely call it an ambulance as it was more like an old fashioned minibus with two stretchers down each side with not much else inside. They were painted white with a blue light on top and the words ambulance on them… so it must have been kosher! The poor victims seemed pretty shaken up but otherwise ok and were sent off to the nearby mission hospital for further check ups.

The army arrive 

 Just as we attempt to get ourselves to the front of the throng of people a huge red army vehicle pulls up and the guys in fatigues get out. This made it easier as they knew Wisdom and we not only got to the front but also got a pair of gloves each.  It was also a welcome sight as it meant there would at least be somebody in charge now or so I thought. We now see the wreckage of the cabin and could see that there are three bodies moving but trapped inside and one that was clearly deceased. We got somebody to cover him up for some dignity and then established what was going on inside the lorry. Some of the locals had been trying to jack up and cut  the door off (with a pneumatic drill hooked up to a generator – who knows where that had come from). The army then got their stuff out and begin the job of trying to cut through as the fire brigade hadnt arrived at this point. 

The army take some control of the situation and do at least get the crowd to stand back a bit. But there is nobody really in control - nobody at all is directing matters and there are people trying to jack or cut the cab open of their own accord 

Hospital medic standing ready with fluids when he is able to get to the guy in the cab

Thumbs up to Wisdom that the guy is talking and alive

I now am joined by another two hospital doctors (general medical doctors from the mission hospital who have arrived with another ambulance). We ascertain that the driver is pinned down under the cab by both his legs and is yelling in agony but alive. There is another man held by his leg on the far side and also a guy trapped at the back by his hand. We ask for cannulas and were surprisingly handed some (though they were paediatric sized – yellow and blue – those familiar with Pouseille’s law will understand that shorter and fatter cannula’s will allow fluid to be delivered much quicker than very small diameter cannulae!) Still we got them in despite having to hang into the cabin and got some fluid trickling in – they’d been trapped for almost 2 hours at this point in the baking sun. There was frustratingly and distressingly no analgesia to give in any shape or form.

Fire brigade and ambulance in front of the village

Fire brigade in all their gear cutting into the crushed cab

 With the pneumatic equipment jiggling the cab up and down you can imagine it wasn’t the most pleasant for the poor guys inside. Eventually the fire brigade turn up and start cutting on the other side. I did feel dreadfully sorry for them too in full gear sweating profusely under the midday sun. It was so hot that in the two hours I was stood there I got sunburnt so they must have cooked. It was over an hour before the traffic police made an appearance!

Traffic police arrive late!

  It took ages before they eventually managed to free up the guy held by one leg and complaining of neck pain. As they were nearing extraction I managed to get a message for the ambulance to back up towards us. It was with great surprise a big van came towards me through the parting crowd. It was a brand spanking new model. It seems the government has invested in two of these per big hospital. It is kitted out with everything you can think of including a ventilator and also a resuscitaire for transporting babies. Amazing. So we got some of the splints and the spinal board out ready (there was no cervical collar). Meanwhile they managed to free him and then just hoiked him out. Literally! Three men carried him via his two arms and one good leg past us with the stretcher and splints. He is howling in pain but with the crowds cheering and clapping and praying out loud it is less audible. They practically throw him into the van. So much for protecting the spine! A quick once over sees that he is conscious and his pulse isn’t too fast but he is in lots of pain in his neck and leg but his pelvis seems ok. We managed to make a collar of sorts out of a rolled up chitengi to try and keep his neck in a more stable condition for the transfer and wrap his pelvis up just in case too. We splint his clearly broken leg, hang up the fluid. Again find there is no analgesia on board (or oxygen for that mater!) and they then whizz off to the hospital with him as the others are a way off being released.

I later found out that these new ambulances have been around for a few months but as yet there are no paramedics – only drivers. There are no paramedics in Zambia at all but the first cohort have gone to Botswana to do a 6 month course. So that will at least be a good start when they return and get to work. Well it couldn’t be any worse!

Brand new MoH ambulances - 2 per hospital but as yet no paramedics....

The next hour (so into the third hour of entrapment) sees the guy trapped by his hand freed up. He has not so much broken his hand but pretty much smashed it completely. There wasn’t a bone that I could see looking as it should be. He had some nasty burns on the side of his face too where I suspect he had been trapped against heated metal as he had blistering of the face. He however didn’t exhibit any signs of airway burns so was also put into one of the less impressive ambulances with no equipment. So I had to improvise and use the upturning of his t-shirt to splint his mangled limb and they sped him off in a scoop and run fashion.

Now the difficult part was the poor driver rapped by his legs. The whole weight of the cabin was bearing down on him. However the weight of the logs on the trailer were bearing down on the cabin also making it impossible to jack it up manually – they tried. They then backed up another lorry and set up a pulley system and manually tried to lift the cab but again to no avail as the logs behind made this impossible.

Manual pulley system being set up on the back of another lorry to try and lift the cab

 Cutting bits of metal away was now becoming a risky task as they too potentially were removing anything that was holding some of the weight off him. There was no other option but to wait for the crane to come from Lusaka. By now we have to leave as it was getting late into the afternoon and we had another 5 hours ahead of us and a drive through the national park to negotiate – meeting an elephant in the road in the darkness is not advised. Also its at night that many of the significant crashes happen also so we ended up having to leave before the crane arrived. To be honest as I had no analgesia to give it was a fairly mute state of affairs staying at that point too.

We get to Mongu in the dark and stay at a motel. I checked into my room and just as I was about to get into the shower to wash away some of the oil and dust from the accident there's a knock on the door. Its the 'manager'. He apologises profusely about the decor in the room. I look around at the magnolia white walls and miss his point completely. He tells me I'm being moved to a far more suitable and feminine room. Cue getting moved to the room with the psychadelic pink walls. He at least is happier! That night I didn't sleep much - I'm not entirely sure if it was the accident or the pink walls that contributed to this the most!

Once we finished in Mongu (the details in another blog) we head back to Lusaka and inevitably pass the scene of yesterday's carnage. We could see that the lorry cab had been righted and the damage to it was particularly evident. We could also see the  company had sent out a replacement lorry and was collecting the timber supplies on to it via the very crane that was used to eventually extract the driver. 

Mangled cab now been righted on our return

Loading up the timber onto a new lorry

Talking with some of the workers and villagers the crane was another 3 hours after we left before it arrived (circa 7 hours of entrapment for that poor man). The latest from the hospital was that he had broken both his femurs and had need blood transfusions and an operation. The man with the mangled hand and burns was ok but was going to have to go to Lusaka for treatment and the guy with the broken leg that was thrown into the back of the ambulance had also broken his neck…. I was very glad we had got something around his neck for a bit of support. The workers and villagers were very thankful for our help but their chat soon turned back to the loading of the lorry as the boss yelled at them to get back to work. Its heartbreaking how very cheap lives are out here.

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