Medical Services Chaos and Surgeons Contributions During Arab Spring

1. Abdelhakim T. Elkholy MBBCH,FACS
ATLS CHAIRPERSON EGYPT

2. Aknowlegement
Dr.Mohamed Alasmar
MBBCH, MRCS
 National coordinator and Instructor ATLS-
Egypt
 General Surgery Resident, Ahmed Maher
Teaching Hospital
 Visitor Resident, KasrAlainy Hospital – Cairo
University

3. All pictures and cases are real and taken
from the scene of events .

5. 25 January 2011
Low velocity shot-gun injuries.
Multiple casualty event.

7. Police officers were attending in the
resuscitation rooms.
All pictures were taken secretly by
mobile phone camera !

8. 28 January 2011
 Fatal injuries (shooting to kill !).
 Mass casualty incidents.
 No disaster management plan was present or
applied.
 All doctors from all specialties worked in the
casualty reception and all on-call consultants
came to the hospital
 All elective surgeries stopped.
 Collapse of medical service, communication
and security.

9. - Cairo University Hospital.
- The biggest hospital with a 5200-beds
capacity.
- It is tertiary ,referral center for all hospitals
in Egypt .
- It is the closest hospital to Tahrir Square.

11. Evidence of an Emerging Pattern of Regime’s
Organized Escalating Violence
During 10 Hours on the Night of January
28, 2011
Published Article in Annals of Surgery, 2012
Mohamed D. Sarhan, MD, MRCS, Ashraf A.
Dahaba, MD, MSc, PhD, Michael Marco, MD, MSc, and Ayman
Salah, MD

12. Published Article in Annals of
Surgery
 Of 3012 casualties, 453 were triaged as “immediate
care” patients.
 On arrival, 339 of 453 patients (74.8%) needed
surgical intervention within 6 hours of arrival
whereas 74 of 453 patients (16.3%) were managed
conservatively.
 Forty of 453 (8.8%) of patients did not survive their
injuries. Most of the inpatients (302/453, 66.6%)
were admitted within 10 hours on January
28, 2011, during which evidence of a pattern of
regime’s organized escalating violence emerged.

13. Patterns of injuries
 Firearms resulted in the majority of injuries (93.1%)
 Stab wounds (3.5%)
 Blunt trauma from stone throwing (2.6%)
 Tear gas inhalation (0.4%)

14. Sites of injuries
 The most common sites of injury were the head and neck
(52.9%).
 the upper and lower extremities (18.1%).
 abdominal area (13.6%).
 chest (9%).
 multiple firearm injuries (6.1%)

15. Case scenarios
 Some Cases presented during the revolution.

18.  Gunshot: entrance  Rt. Lower chest and
exitLt. neck .
 Presented hemodynamically unstable and
unfortunately died due to extension of the
vascular injury to major vessels.

23.  Shotgun left hemi-thorax and left upper
quadrant of the abdomen.
 Patient presented hemodynamicaly unstable
and Splenectomy was done but patient died
due to extensive hematemesis.

27. Shotgun to the back.
Patient presented with hematuria.
Admitted under observation.
Patient discharged.

33.  Shotgun to the back.
 Presented with right pneumothorax and
paraplegia.

39.  Shotgun umbilical region presented 24 hours
after the injury.
 Multiple small bowel perforation.
 Patient died after 2 weeks due to septicemia.
 It was noticed that the effect of small pellet
may be delayed and this issue is under
research now.

41. Gunshot to the chest ;

42. Patient presented to‘Ahmed Maher Teaching
Hospital’ without cardiothoracic surgeons !!
 Hemodinamicaly stable middle-aged male
patient.
 Gunshot to the chest.
 no communication method as the government
cut all methods of communication.
 You can not transfer patients as there is no way
of communication.
 Conflict between people and police increased the
problem of security.

44. How can we solve the security
problem??

46. Not only physicians, nurses and hospital
workers but also patients relatives and
even some patients share in securing the
hospitals and protecting medical staff.

48. Thank you…..