The study included patients who presented and were registered at the Emergency Department of the Mogadishu Somalia Turkish Training and Research Hospital following the explosion caused by a suicide bomber with a truck loaded with explosives in the Somalian capital, Mogadishu on 14 October 2017. A retrospective examination was made of the records of the patients who were affected by the explosion and presented at our hospital. The data were retrieved from the hospital information management system, patient examination forms and patient files. The ethical board approval for the study was obtained.
On the day of the attack, more than 300 patients affected by the explosion presented at the hospital. All the patients who could be registered were those with life-threatening injuries who required immediate care, classified as code red triage, and those who required the care of a physician to prevent permanent damage but could wait, who were classified as code yellow. All patients were examined by the care of a physician but the patients could wait a longer time were triage classified as code green. This group, estimated to be approximately 50 patients, were not registered and were discharged after the application of dressings.
The patients included in the study were classified according to age, gender, triage code, location of major injury, department to which admitted, and discharge and/or exitus status. Patients not considered to have life-threatening priority were classified as superficial injuries (foreign body only, minimal burns, abrasion, minimal burn, laceration and superfisial foreign body). Patients with life-threatening injuries, who required follow-up or surgery were classified according to the anatomic region of the lesion. Patients evaluated with life-threatening multi-trauma were classified on the basis of the Abbreviated Injury Scale. In this scale, the body is divided into 4 main areas as the head-neck, extremities, thorax and abdomen, and trauma in at least 2 regions is accepted as multi-trauma (9).
Management of Patients on Admission
On the day of the explosion, 1 Emergency Medicine specialist and 2 residents were working in the Emergency Department (ED) of our hospital, which is 1,4 km from the location of the attack. There were 29 other doctors on duty in the hospital at that time, comprising 3 anaesthesia and reanimation specialists, 2 general surgery specialists, 2 brain surgery specialists, 1 orthopaedics and traumatology specialist, 1 thoracic surgery specialist, 1 paediatric surgery specialist, 1 ophthalmology diseases specialist, 2 ear, nose and throat diseases specialists, 1 urology specialist and 14 internal- basic branch specialist doctors (biochemistry, internal, paediatric, neurology, cardiology and radiology). The total bed capacity of the hospital is 219, including 2 separate 20-bed intensive care units.
The first casualties of the explosion reached the hospital ED approximately 20 mins after the explosion and continued to arrive for a period of 2 hours. The hospital administration reacted to the event very rapidly from the first moment and organised additional beds in the wards in the hospital which was on average 70% full at that time. Elective surgical cases were cancelled and patients in the wards who could be discharged were discharged immediately. In the ED, the wounded were taken to the 6-bed capacity yellow area, the 6-bed capacity green area, the resuscitation room, 2 trauma rooms and as there was insufficient space, the waiting room was also used.
First interventions to the patients were made by the rapidly formed trauma team, patients were transferred to the wards and it was attempted to decrease the intensity in ED. Within approximately 4 hours, the intensity in ED had reduced and in the following hours, patient admissions continued until late in the night with patients referred from other centres. Two different doctor teams were established for patients presenting at the hospital. The first of these (surgical branches and emergency specialists) admitted the patients and after the first intervention transferred them urgently to the relevant departments. The evaluated patients were admitted to the relevant units according to the part of the body most affected. Patients with an emergency clinical status were admitted for surgery, and an order of priority was established for those who were relatively elective. Patients with less severe injuries who could be followed up as out-patients were discharged after observation and re-called for further examination.
Statistical analyses of these parameters were made using SPSS vn 22.0 software. Numbers and percentage values were given for categorical variables as descriptive statistics.