R report
// fire in brazil
lactated Ringer’s and medications were also donated to Santa Maria. Hospitals in Porto Alegre started managing emergency departments and intensive care units to arrange as many ICU beds as possible to receive the victims from the fire. Recovery rooms were transformed into ICU beds, elective surgeries were canceled, emergency departments doubled their staff. Regardless of the lack of ICU beds in the city of Porto Alegre, 105 beds became available for the fire’s victims among public and private hospitals. Everybody started working for the same cause; even the population of Porto Alegre agreed to seek help only in emergency cases in order to leave more space for the burn victims. The physicians who volunteered to go to Santa Maria were designated to lead and attend the aeromedical transport. The aeromedical team consisted basically of emergency physicians. Even though emergency medicine is not a recognized specialty in Brazil, Porto Alegre has had an emergency medicine training program since 1994. The emergency physicians divided themselves in two groups: one to take care of the air transport and the other to manage the
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emergency departments among the private and public hospitals. This made the distribution of the beds much easier. The transports were made by military aircrafts and in 48 hours, 72 patients were transferred to Porto Alegre. All of the victims were intubated and the majority of them were already using vasopressors. Even though the victims were critical there were no complications or deaths in any displacements. There were 6-7 patients carried by plane and 1-2 by helicopter at a time. The amount varied according to the number of physicians available per flight. After 92 flights the transports stopped, leaving the city of Santa Maria with an adequate number of occupied beds for an ideal assistance. New technologies played a strong role throughout the emergency response. Portable ultrasound was crucial, especially when used as a guide to detect pneumothorax before the air transport. This helped to reduce the need of hospital staff involved with a patient. Telemedicine was another key element to this disaster response. We had conference calls with experts from all over the world about the best ways to treat the burn victims, especially the cases of smoke
Spring 2013 // Emergency Physicians International
inhalation. The lung problems we had were very similar to the ones Argentina saw in 2004 during a nightclub fire at the República Cromañón where 194 people died. There were 7 telemedicine meetings and this interaction among other centers became indispensable. Today a lot of the burden falls on the psychiatrists and psychologists who are in Santa Maria dealing with the mourning of the survivors, families and anyone else involved in this tragedy. The chain of survival continues, and hopefully those who are still hospitalized are going to be able to go home safe and sound. Disaster Preparedness: Fire Safety
It’s believed that the major fire safety hazards contributing to this death trap were the lack of exit doors – there was only one – and the lack of security personnel to control the situation. Having only one exit door for 950 panicked people –not to mention no emergency lights – was a clear disaster waiting to happen. In their confusion many club goers ran into the bathroom, thinking it was an exit, and couldn’t get out in time.