Featured Terrorism and casualty care in Balochistan

[RescueRanger]

Terrorism and Casualty care in Balochistan

Written by: RescueRanger​

Category cloud: Opinion, analysis​

Pakistan is a front line state in the global war against terrorism, the nation and people of Pakistan are victims of terrorism and have been so for the last many years. In a report published in 2019 by the Pakistan Institute of Peace Studies (PIPS), it was revealed that the number of attacks had reduced by 13% compared to figures in 2018, the number of casualties from terrorism incidents also saw a reduction of over 40%. [1]

Whilst these numbers provide solace that the scourge of terrorism in the country is on the decline, it offers little comfort to the loved ones of innocent victims caught up in acts of terrorism.

Table 1: Shows the number of terrorism incidents in various provinces of Pakistan.

Based on available data from 2019, KPK was the province with the highest number of terrorism incidents, however Balochistan with a considerably lower number of incidents witnessed greater casualties. [1]

In her joint study covering patterns of injury witnessed in patients presenting to accident and emergency at CMH, Quetta Dr. Alia Rasikh and her team discovered that out of the total of 3034 patients reported to the hospital between 2012-2015, 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. [2]

Dr Rasikh and her team concluded that based on their findings the M=majority of the injured had multi-system injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the sub-specialities' should include orthopaedics, vascular, thoracic and neurosurgery.

A further study carried out a multidisciplinary team at the Pakistan Journal of Public Health into the preparedness of hospitals in Balochistan and pre-hospital care found that 'People mostly rely on the trauma management facilities of military hospitals in emergency situations. Study revealed that 80 percent of the hospitals were without any formal written plan. Major weaknesses observed were regarding training of staff, mental health services, hospital networking, security of facility, and lack of an organised system of pre-hospital management of casualties.'[3]

And the perhaps the key difference here between the disparity of casualties vs number of incidents between KPK and Balochistan is the lack of a well trained and organised pre-hospital ambulance service.

Challenges for EMS/Prehospital care providers in Balochistan:

1. Terrain, unlike Quetta or even KPK, Balochistan is a very large part of the country with varying degree of paved roads, dirt tracks and impassable rugged terrain, this makes access to traditional ambulance operations somewhat difficult.

Figure 1: A Map of hospitals in Balochistan Province.

Critical patient care can be categorised by severity, distance and time:

1. Severity - the life-threatening injuries sustained by the casualty and deterioration in the minutes that follow.
2. Distance - The actual road miles to the incident and the subsequent transportation time to the hospital
3. Time - The time taken for the whole rescue team to respond to the incident and remove the casualty.

The Golden Hour:
Emergency Doctors and surgeons the world over will talk about the importance of the Golden Hour, the term “golden hour” is a well-known lexicon among trauma surgeons and emergency medical service (EMS) providers who care for injured patients on a daily basis. The underlying tenet of this adage suggests an injured patient has 60 min from time of injury to receive definitive care, after which morbidity and mortality significantly increase. [4]

Figure 2: A graph explaining the timeline of prehospital and in hospital care.

P.10 / Platinum 10:
An accident can happen anywhere, anytime and because the attendance time to an incident is an unknown quantity, for all practical purposes it cannot be introduced as part of the equation. Therefore the Platinum Ten is the first 10 minutes following the arrival of the key players in the rescue team.

Figure 3: Col. Bellamy's study into causes of combat deaths in Vietnam.

As terrorism injuries often resemble those injuries sustained by soldiers in combat, examining Colonel Ron Bellamy's study on combat injury and trauma care Bellamy (Figure 3) found that massive haemorrhage from extremities comprised over 9% of the all deaths in Vietnam. However, of the leading three causes of preventable death, it was about 60%.[5]

​

Figure 4: Eastridge BJ et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7

Eastridge et al. (Figure 4) found 91% of the potentially survivable patients died from haemorrhage. Since 2001, there have been over 2,000,000 deaths from trauma[6]. In addition to the above the victims of a terrorism incident may or may not be victims of blast injuries, according to the latest guidelines published in the Tactical Combat Casualty Care Handbook; blast injury mechanisms can be categorised into 4 types:

Figure 5: primary, secondary and tertiary blast injuries on the human body.

• Type 1: Overpressure injury to hollow organs (ears, lungs, intestines)
• Type 2: Penetrating injuries caused by flying debris
• Type 3: Blunt injuries caused by physical displacement of victim by blast
• Type 4: Associated injuries such as chemical exposures, psychiatric sequelae, crush injury, etc.

The most common clinical findings are:
a. Dyspnea or rapid shallow respirations
b. Decreased breath sounds (possible pneumothorax or lung contusion)
c. Hypoxia, cyanosis, anxiety, or apathy
d. Cough or hemoptysis (possibly severe enough to require airway management)
e. Chest pain, bradycardia, and hypotension
f. Penetrating neck or torso trauma, skull fracture, spinal injury, long-bone
fractures, or traumatic amputations, >10% BSA burn, or inhalational injury in
enclosed spaces
g. Ruptured tympanic membrane [7]

The dilapidated healthcare system in Balochistan is not equipped to provide this level of care both in and out of hospital, in addition to the challenges presented by the security, political, economic and social dynamics of the province, the provincial prehospital care system relies on the voluntary effort of EDHI Ambulance, which whilst a very noble and admirable effort is not designed to provide critical patient care.

Figure 6: A local ambulance in Quetta.

Local ambulances are provided by charitable trusts like EDHI which are not staffed by appropriately trained EMT's not are they equipped for critical patient care with equipment such as patient monitors, AED's, Oxygen, Suction and the like.

The lack of these facilities further reduces the survival chances of victims of catastrophic haemorrhages, mass-casualty incidents and blast injuries. Balochistan like Karachi has delayed the induction of a Rescue 1122 office.

Recommendations:

• PDMA Balochistan should engage with NSET (PEER) to run HOPE (Hospital Preparedness for Emergencies) courses to develop surge capacity within major hospitals in the province to handle at minimum 50% more than the normal maximum number of trauma patients.
• Balochistan has over 653 Basic Health Units and Health Facilities BHUs/HFs across thirty-three districts of Balochistan, several of these could be used for the establishment of a pilot 1122 helpline complete with CAD (Computer Aided Dispatch), Command and Control, trunked radio service with redundancies and an emergency ambulance and rescue service between Quetta and the N-50 Highway.
• First Responder training for law enforcement: Quetta and Balochistan has a very high law enforcement presence, in most situations the law enforcement officers are first responders in their areas, this is a missed opportunity to develop viable human capacity as a life saving resource. Short of investing in complex first aid courses for police officers and FC, localised training can be run to cover the basics of trauma care to include basic life support and bleeding control, this will help bridge the gap between the casualty being discovered and the ambulance arriving.

References:
[1] Pakistan Security Report 2019, Pakistan Institute of Peace Studies, Islamabad.
[2] Pattern of Injuries Seen in Mass Casualties in Terrorist Attacks in Balocistan, Pakistan - A three year experience, Journal of Ayub Medical College Abbottabad, Dec 2015, Maqsood-R, Rasikh-A et.al PMID: 27004339.
[3] Challenges of Hospital Preparedness in Disasters in Balochistan, 2017, Latif N, Et.Al, Pakistan Journal of Public Health, Vol 7, No1 PP 22.
[4] PHTLS: Prehospital Trauma Life Support Manual 8th Edition, Nov 2014, National Association of Emergency Medical Technicians, USA.
[5] Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149(2):55–62. Based on the Wound Data Munitions Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969.
[6] Eastridge BJ, Mabry RL, Seguin PG, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7
[7] Tactical Combat Casualty Care Handbook, AMEDD Centre and School, US ARMY, USA.

 

[RescueRanger]

@BHarwana @krash @jaibi @Slav Defence @WAJsal @Irfan Baloch @Arsalan

 

[Irfan Baloch]

@BHarwana @krash @jaibi @Slav Defence @WAJsal @Irfan Baloch @Arsalan

thanks for tagging
nice work

 

[BHarwana]

@BHarwana @krash @jaibi @Slav Defence @WAJsal @Irfan Baloch @Arsalan

Thanks for tagging bro. Will give it a through reading.

 

[Arsalan]

Need to put this on Home Page and SM. Great read and what a detailed and in-depth analysis of the whole situation.

 

[RescueRanger]

Need to put this on Home Page and SM. Great read and what a detailed and in-depth analysis of the whole situation.

Thank you very much brother, just my two cents.

 

[Muhammed45]

View attachment 647348
Terrorism and Casualty care in Balochistan

Written by: RescueRanger​

Category cloud: Opinion, analysis​

Pakistan is a front line state in the global war against terrorism, the nation and people of Pakistan are victims of terrorism and have been so for the last many years. In a report published in 2019 by the Pakistan Institute of Peace Studies (PIPS), it was revealed that the number of attacks had reduced by 13% compared to figures in 2018, the number of casualties from terrorism incidents also saw a reduction of over 40%. [1]

Whilst these numbers provide solace that the scourge of terrorism in the country is on the decline, it offers little comfort to the loved ones of innocent victims caught up in acts of terrorism.

View attachment 647350​

Table 1: Shows the number of terrorism incidents in various provinces of Pakistan.

Based on available data from 2019, KPK was the province with the highest number of terrorism incidents, however Balochistan with a considerably lower number of incidents witnessed greater casualties. [1]

In her joint study covering patterns of injury witnessed in patients presenting to accident and emergency at CMH, Quetta Dr. Alia Rasikh and her team discovered that out of the total of 3034 patients reported to the hospital between 2012-2015, 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. [2]

Dr Rasikh and her team concluded that based on their findings the M=majority of the injured had multi-system injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the sub-specialities' should include orthopaedics, vascular, thoracic and neurosurgery.

A further study carried out a multidisciplinary team at the Pakistan Journal of Public Health into the preparedness of hospitals in Balochistan and pre-hospital care found that 'People mostly rely on the trauma management facilities of military hospitals in emergency situations. Study revealed that 80 percent of the hospitals were without any formal written plan. Major weaknesses observed were regarding training of staff, mental health services, hospital networking, security of facility, and lack of an organised system of pre-hospital management of casualties.'[3]

And the perhaps the key difference here between the disparity of casualties vs number of incidents between KPK and Balochistan is the lack of a well trained and organised pre-hospital ambulance service.

Challenges for EMS/Prehospital care providers in Balochistan:

1. Terrain, unlike Quetta or even KPK, Balochistan is a very large part of the country with varying degree of paved roads, dirt tracks and impassable rugged terrain, this makes access to traditional ambulance operations somewhat difficult.

View attachment 647351​

Figure 1: A Map of hospitals in Balochistan Province.

Critical patient care can be categorised by severity, distance and time:

1. Severity - the life-threatening injuries sustained by the casualty and deterioration in the minutes that follow.
2. Distance - The actual road miles to the incident and the subsequent transportation time to the hospital
3. Time - The time taken for the whole rescue team to respond to the incident and remove the casualty.

The Golden Hour:
Emergency Doctors and surgeons the world over will talk about the importance of the Golden Hour, the term “golden hour” is a well-known lexicon among trauma surgeons and emergency medical service (EMS) providers who care for injured patients on a daily basis. The underlying tenet of this adage suggests an injured patient has 60 min from time of injury to receive definitive care, after which morbidity and mortality significantly increase. [4]

Figure 2: A graph explaining the timeline of prehospital and in hospital care.

P.10 / Platinum 10:
An accident can happen anywhere, anytime and because the attendance time to an incident is an unknown quantity, for all practical purposes it cannot be introduced as part of the equation. Therefore the Platinum Ten is the first 10 minutes following the arrival of the key players in the rescue team.

Figure 3: Col. Bellamy's study into causes of combat deaths in Vietnam.

As terrorism injuries often resemble those injuries sustained by soldiers in combat, examining Colonel Ron Bellamy's study on combat injury and trauma care Bellamy (Figure 3) found that massive haemorrhage from extremities comprised over 9% of the all deaths in Vietnam. However, of the leading three causes of preventable death, it was about 60%.[5]

​

Figure 4: Eastridge BJ et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7

Eastridge et al. (Figure 4) found 91% of the potentially survivable patients died from haemorrhage. Since 2001, there have been over 2,000,000 deaths from trauma[6]. In addition to the above the victims of a terrorism incident may or may not be victims of blast injuries, according to the latest guidelines published in the Tactical Combat Casualty Care Handbook; blast injury mechanisms can be categorised into 4 types:

Figure 5: primary, secondary and tertiary blast injuries on the human body.

• Type 1: Overpressure injury to hollow organs (ears, lungs, intestines)
• Type 2: Penetrating injuries caused by flying debris
• Type 3: Blunt injuries caused by physical displacement of victim by blast
• Type 4: Associated injuries such as chemical exposures, psychiatric sequelae, crush injury, etc.

The most common clinical findings are:
a. Dyspnea or rapid shallow respirations
b. Decreased breath sounds (possible pneumothorax or lung contusion)
c. Hypoxia, cyanosis, anxiety, or apathy
d. Cough or hemoptysis (possibly severe enough to require airway management)
e. Chest pain, bradycardia, and hypotension
f. Penetrating neck or torso trauma, skull fracture, spinal injury, long-bone
fractures, or traumatic amputations, >10% BSA burn, or inhalational injury in
enclosed spaces
g. Ruptured tympanic membrane [7]

The dilapidated healthcare system in Balochistan is not equipped to provide this level of care both in and out of hospital, in addition to the challenges presented by the security, political, economic and social dynamics of the province, the provincial prehospital care system relies on the voluntary effort of EDHI Ambulance, which whilst a very noble and admirable effort is not designed to provide critical patient care.

Figure 6: A local ambulance in Quetta.

Local ambulances are provided by charitable trusts like EDHI which are not staffed by appropriately trained EMT's not are they equipped for critical patient care with equipment such as patient monitors, AED's, Oxygen, Suction and the like.

The lack of these facilities further reduces the survival chances of victims of catastrophic haemorrhages, mass-casualty incidents and blast injuries. Balochistan like Karachi has delayed the induction of a Rescue 1122 office.

Recommendations:

• PDMA Balochistan should engage with NSET (PEER) to run HOPE (Hospital Preparedness for Emergencies) courses to develop surge capacity within major hospitals in the province to handle at minimum 50% more than the normal maximum number of trauma patients.
• Balochistan has over 653 Basic Health Units and Health Facilities BHUs/HFs across thirty-three districts of Balochistan, several of these could be used for the establishment of a pilot 1122 helpline complete with CAD (Computer Aided Dispatch), Command and Control, trunked radio service with redundancies and an emergency ambulance and rescue service between Quetta and the N-50 Highway.
• First Responder training for law enforcement: Quetta and Balochistan has a very high law enforcement presence, in most situations the law enforcement officers are first responders in their areas, this is a missed opportunity to develop viable human capacity as a life saving resource. Short of investing in complex first aid courses for police officers and FC, localised training can be run to cover the basics of trauma care to include basic life support and bleeding control, this will help bridge the gap between the casualty being discovered and the ambulance arriving.

References:
[1] Pakistan Security Report 2019, Pakistan Institute of Peace Studies, Islamabad.
[2] Pattern of Injuries Seen in Mass Casualties in Terrorist Attacks in Balocistan, Pakistan - A three year experience, Journal of Ayub Medical College Abbottabad, Dec 2015, Maqsood-R, Rasikh-A et.al PMID: 27004339.
[3] Challenges of Hospital Preparedness in Disasters in Balochistan, 2017, Latif N, Et.Al, Pakistan Journal of Public Health, Vol 7, No1 PP 22.
[4] PHTLS: Prehospital Trauma Life Support Manual 8th Edition, Nov 2014, National Association of Emergency Medical Technicians, USA.
[5] Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149(2):55–62. Based on the Wound Data Munitions Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969.
[6] Eastridge BJ, Mabry RL, Seguin PG, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7
[7] Tactical Combat Casualty Care Handbook, AMEDD Centre and School, US ARMY, USA.

I can remember when IRGC offered Pakistan with a Intelligence cooperation pact. I could Read their mind, they were offering Pakistani side with the most important basis that IRGC itself was built upon, in other words IRGC suggested Pakistanis with its vital information.

This suggestion which was ignore by Pakistanis by God knows why, could simply end terrorism in Pakistan and save hundreds of innocent lives.

IRGC itself is built upon Basij which makes it in contact with all levels of Iranian society. Drug dealers, terrorists, separatists etc are countered by Baluch people themselves. You may not believe that IRGC has plenty of Sunni generals in that province countering terrorists and Drug dealers. IRGC model is giving power to the residents of respected area to counter terrorism Regardless of their religious belief. I wish and pray to almighty terrorism ends in Baluchistan once and forever. Its a must for prosperity of that area.

 

[jaibi]

Wonderfully done, sir.

View attachment 647348
Terrorism and Casualty care in Balochistan

Written by: RescueRanger​

Category cloud: Opinion, analysis​

Pakistan is a front line state in the global war against terrorism, the nation and people of Pakistan are victims of terrorism and have been so for the last many years. In a report published in 2019 by the Pakistan Institute of Peace Studies (PIPS), it was revealed that the number of attacks had reduced by 13% compared to figures in 2018, the number of casualties from terrorism incidents also saw a reduction of over 40%. [1]

Whilst these numbers provide solace that the scourge of terrorism in the country is on the decline, it offers little comfort to the loved ones of innocent victims caught up in acts of terrorism.

View attachment 647350​

Table 1: Shows the number of terrorism incidents in various provinces of Pakistan.

Based on available data from 2019, KPK was the province with the highest number of terrorism incidents, however Balochistan with a considerably lower number of incidents witnessed greater casualties. [1]

In her joint study covering patterns of injury witnessed in patients presenting to accident and emergency at CMH, Quetta Dr. Alia Rasikh and her team discovered that out of the total of 3034 patients reported to the hospital between 2012-2015, 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. [2]

Dr Rasikh and her team concluded that based on their findings the M=majority of the injured had multi-system injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the sub-specialities' should include orthopaedics, vascular, thoracic and neurosurgery.

A further study carried out a multidisciplinary team at the Pakistan Journal of Public Health into the preparedness of hospitals in Balochistan and pre-hospital care found that 'People mostly rely on the trauma management facilities of military hospitals in emergency situations. Study revealed that 80 percent of the hospitals were without any formal written plan. Major weaknesses observed were regarding training of staff, mental health services, hospital networking, security of facility, and lack of an organised system of pre-hospital management of casualties.'[3]

And the perhaps the key difference here between the disparity of casualties vs number of incidents between KPK and Balochistan is the lack of a well trained and organised pre-hospital ambulance service.

Challenges for EMS/Prehospital care providers in Balochistan:

1. Terrain, unlike Quetta or even KPK, Balochistan is a very large part of the country with varying degree of paved roads, dirt tracks and impassable rugged terrain, this makes access to traditional ambulance operations somewhat difficult.

View attachment 647351​

Figure 1: A Map of hospitals in Balochistan Province.

Critical patient care can be categorised by severity, distance and time:

1. Severity - the life-threatening injuries sustained by the casualty and deterioration in the minutes that follow.
2. Distance - The actual road miles to the incident and the subsequent transportation time to the hospital
3. Time - The time taken for the whole rescue team to respond to the incident and remove the casualty.

The Golden Hour:
Emergency Doctors and surgeons the world over will talk about the importance of the Golden Hour, the term “golden hour” is a well-known lexicon among trauma surgeons and emergency medical service (EMS) providers who care for injured patients on a daily basis. The underlying tenet of this adage suggests an injured patient has 60 min from time of injury to receive definitive care, after which morbidity and mortality significantly increase. [4]

Figure 2: A graph explaining the timeline of prehospital and in hospital care.

P.10 / Platinum 10:
An accident can happen anywhere, anytime and because the attendance time to an incident is an unknown quantity, for all practical purposes it cannot be introduced as part of the equation. Therefore the Platinum Ten is the first 10 minutes following the arrival of the key players in the rescue team.

Figure 3: Col. Bellamy's study into causes of combat deaths in Vietnam.

As terrorism injuries often resemble those injuries sustained by soldiers in combat, examining Colonel Ron Bellamy's study on combat injury and trauma care Bellamy (Figure 3) found that massive haemorrhage from extremities comprised over 9% of the all deaths in Vietnam. However, of the leading three causes of preventable death, it was about 60%.[5]

​

Figure 4: Eastridge BJ et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7

Eastridge et al. (Figure 4) found 91% of the potentially survivable patients died from haemorrhage. Since 2001, there have been over 2,000,000 deaths from trauma[6]. In addition to the above the victims of a terrorism incident may or may not be victims of blast injuries, according to the latest guidelines published in the Tactical Combat Casualty Care Handbook; blast injury mechanisms can be categorised into 4 types:

Figure 5: primary, secondary and tertiary blast injuries on the human body.

• Type 1: Overpressure injury to hollow organs (ears, lungs, intestines)
• Type 2: Penetrating injuries caused by flying debris
• Type 3: Blunt injuries caused by physical displacement of victim by blast
• Type 4: Associated injuries such as chemical exposures, psychiatric sequelae, crush injury, etc.

The most common clinical findings are:
a. Dyspnea or rapid shallow respirations
b. Decreased breath sounds (possible pneumothorax or lung contusion)
c. Hypoxia, cyanosis, anxiety, or apathy
d. Cough or hemoptysis (possibly severe enough to require airway management)
e. Chest pain, bradycardia, and hypotension
f. Penetrating neck or torso trauma, skull fracture, spinal injury, long-bone
fractures, or traumatic amputations, >10% BSA burn, or inhalational injury in
enclosed spaces
g. Ruptured tympanic membrane [7]

The dilapidated healthcare system in Balochistan is not equipped to provide this level of care both in and out of hospital, in addition to the challenges presented by the security, political, economic and social dynamics of the province, the provincial prehospital care system relies on the voluntary effort of EDHI Ambulance, which whilst a very noble and admirable effort is not designed to provide critical patient care.

Figure 6: A local ambulance in Quetta.

Local ambulances are provided by charitable trusts like EDHI which are not staffed by appropriately trained EMT's not are they equipped for critical patient care with equipment such as patient monitors, AED's, Oxygen, Suction and the like.

The lack of these facilities further reduces the survival chances of victims of catastrophic haemorrhages, mass-casualty incidents and blast injuries. Balochistan like Karachi has delayed the induction of a Rescue 1122 office.

Recommendations:

• PDMA Balochistan should engage with NSET (PEER) to run HOPE (Hospital Preparedness for Emergencies) courses to develop surge capacity within major hospitals in the province to handle at minimum 50% more than the normal maximum number of trauma patients.
• Balochistan has over 653 Basic Health Units and Health Facilities BHUs/HFs across thirty-three districts of Balochistan, several of these could be used for the establishment of a pilot 1122 helpline complete with CAD (Computer Aided Dispatch), Command and Control, trunked radio service with redundancies and an emergency ambulance and rescue service between Quetta and the N-50 Highway.
• First Responder training for law enforcement: Quetta and Balochistan has a very high law enforcement presence, in most situations the law enforcement officers are first responders in their areas, this is a missed opportunity to develop viable human capacity as a life saving resource. Short of investing in complex first aid courses for police officers and FC, localised training can be run to cover the basics of trauma care to include basic life support and bleeding control, this will help bridge the gap between the casualty being discovered and the ambulance arriving.

References:
[1] Pakistan Security Report 2019, Pakistan Institute of Peace Studies, Islamabad.
[2] Pattern of Injuries Seen in Mass Casualties in Terrorist Attacks in Balocistan, Pakistan - A three year experience, Journal of Ayub Medical College Abbottabad, Dec 2015, Maqsood-R, Rasikh-A et.al PMID: 27004339.
[3] Challenges of Hospital Preparedness in Disasters in Balochistan, 2017, Latif N, Et.Al, Pakistan Journal of Public Health, Vol 7, No1 PP 22.
[4] PHTLS: Prehospital Trauma Life Support Manual 8th Edition, Nov 2014, National Association of Emergency Medical Technicians, USA.
[5] Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149(2):55–62. Based on the Wound Data Munitions Effectiveness Team (WDMET) during the Vietnam War between 1967 and 1969.
[6] Eastridge BJ, Mabry RL, Seguin PG, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. Journal of Trauma 2012, 73(6) Suppl 5: 431–7
[7] Tactical Combat Casualty Care Handbook, AMEDD Centre and School, US ARMY, USA.

 

[RescueRanger]

Wonderfully done, sir.

Thank you very much.

 

[Rafeh]

Thank you for a remarkable analysis that personally added to my own learning.

More importantly analysis like this can guide and improve efforts that save lives. Which is a noble act in itself.

I sincerely hope, that such work reaches key decision makers so that they can use such analysis and global overview to add to their own understanding and use it to improve procedures, protocols, and resource availability to save lives as well as to prevent unnecessary disabilities.

Any efforts to lower the suffering of victims of terrorism or even accidents is a noble act that will be rewarded here or hereafter.

Analysis like this create data drive cognition and awareness which is far more likely to initiate positive change in procedures, work ethics and resource allocation than otherwise.

Much appreciated.

 

[RescueRanger]

Thank you for a remarkable analysis that personally added to my own learning.

More importantly analysis like this can guide and improve efforts that save lives. Which is a noble act in itself.

I sincerely hope, that such work reaches key decision makers so that they can use such analysis and global overview to add to their own understanding and use it to improve procedures, protocols, and resource availability to save lives as well as to prevent unnecessary disabilities.

Any efforts to lower the suffering of victims of terrorism or even accidents is a noble act that will be rewarded here or hereafter.

Analysis like this create data drive cognition and awareness which is far more likely to initiate positive change in procedures, work ethics and resource allocation than otherwise.

Much appreciated.

Thank you for your kind words, it is most appreciated.

 

[WebMaster]

Need to put this on Home Page and SM. Great read and what a detailed and in-depth analysis of the whole situation.

Agreed and will be done.

 

[BHarwana]

@BHarwana @krash @jaibi @Slav Defence @WAJsal @Irfan Baloch @Arsalan

Good work bro it is a very good read. Thank you for putting in great effort

 

[YeBeWarned]

Much needed information gathered in one Place. .. Highly Appreciated

 

[Rafi]

Excellent work.