Immediate mass casualty management in Jos University Teaching Hospital: a successful trial of Jos protocol

Traumatic, injuries arising from high velocity means of mobility, increased industrialization, frequent ethnic and religious classes and terrorist activities by way of bomb blasts, etc., often result in sudden unexpected mass casualty presenting to a given secondary or tertiary health institution. The successful management of such situation involves multidimensional and multidisciplinary approach anchored on awareness, preplanning and alertness. In response to the challenge, the orthopaedic and trauma unit of Jos University Teaching Hospital worked out the "Jos Protocol" which embodies the principle and strategy for mass casualty management and response to field distress call to the hospital within the practical limitations of our infrastructure. On the sixth of April, 1997 a vehicular collision in a neighbouring village resulted in twenty nine severely injured patients being rushed to the hospital's accident and emergency unit. By activating the protocol and utilizing the cascade call our system, mutual aid, hospital mobilization, reach out system, modified hospital triage, team work, effective manoeuvers and treatment modification, the immediate rescucitation and stabilization of patients was achieved in five hours. The working team comprised fifteen doctors and some hospital workers who could be reached on a weekend. Out of the mortality of 6 patients, 3 died in the triage zone while 3 were brought in dead. The difficulties encountered during the management and recommendation for improved immediate mass casualty management are discussed. Further, we believe that it has become necessary for every secondary and tertiary health institution to work out a mass casualty management protocol adapted to its peculiar working circumstances. A case is made for the establishment of regional disaster committees.