Five young men die in Male' last night: Inadequate medical rescue services.

Sunday, March 2, 2008

Last night five young men died in Male following an incident at the Male Fish Market. According to news reports the five men suffocated and died when they descended into a deep "well" for some drilling work last night. It is widely speculated in the media and in rumors that they all died as a result of inhalation of toxic gases in the well.

There is a sense of disbelief in the community as to how such a terrible incident could have happened and so many lives lost in this tragic event. We would like to review the events in light of medical knowledge shared with us by our resident doctors.

Safety at work ignored
It has become apparent that safety issues related to this kind of work were ignored in the incident last night. One man after another descended into a poorly ventilated well in an attempt to rescue the people who were "fainting" once inside the well. It is reported in the media that no safety harness, ladder or other rescue/escape mechanism was in place during the preplanned work.

We realize that the detail related to this are still sketchy and that a proper review is in order to find out why safety measures were not in place. It is our belief that worker safety  is ignored in all areas of Maldivian work force. This incident highlights the need for proper planning, including worker safety review when potentially risky work is carried out.

Contacting the rescue services
It has emerged that Maldives Police Services were informed of the incident by witnesses at the site to get aid. A senior MNDF Fire and Rescue personnel complained on national TV that the "real" rescue services (them) were not contacted.

We asked some of our friends about who they would contact in a similar event. The answers we got were not surprising. Most of them said that they would contact MPS or IGMH. The MNDF Fire and Rescue services were mentioned by only one of the 25 people we contacted. This maybe a biased assessment but this highlights one issue. The general public have not been made aware of what emergency service they need to contact in which kind of incident.

This brings us to our argument for the need for a common Emergency Services. Why can't we organize an emergency response service that has teams from various fields (Fire, Rescue, Police, Medical Services) that could be contacted by calling an umbrella Emergency Service?

International practice is to have a single body responsible for Emergency services. They will be comprised of the different teams that will be mobilized to respond to an event. It would them be easier for the common people to know which number to call in an emergency. Much like the 911 service we see on Reality TV.

We also note that the information conveyed at the time of calling the rescue service is vital. If details were not provided by the caller, the person receiving the call should have the sense to keep him or her online and to gather more information till the rescue services could reach the site.

Why couldn't the rescue service reach the site?
We at MMW fail to understand why the MNDF vehicles including their ambulances (yes they do have ambulances) or the Hospital ambulances were unable to reach the site of the event. The vehicles were apparently unable to reach the area because of members of the public gathered around the site as spectators. They stopped 2 blocks away from the site. This is unacceptable.

If the president of the Maldives was to travel any road, at any time, MNDF and MPS would definitely be able to clear roads. Why was this not possible in this incident.

The public are also to blame in this case. There is always a sense of euphoria in Male' when ever something happened and the public gather as spectators. We don't understand why public should, by their own actions, prevent the rescue services from reaching the site. Was this because they were already too late? Not a reason good enough.

The response time, according to reports on national TV was about 30 minutes, far too long for any rescue service! Very slow for a place like Male'.

Why doesn't the Rescue service have medical personnel on the team?

The video footage of the victims being rushed out of the Fish Market on to ambulances (or pick-up trucks) and latter being wheeled into IGMH showed the state of our rescue services.

The victims were clearly in need of resuscitation. Sadly the video footage shown on TVM show the lack of this vital measure. No individual was giving CPR to the victims, a vital intervention that could have proved useful and even life-saving. Doesn't MNDF Fire and Rescue Service personnel have members trained in first-aid? Why wasn't anyone giving mouth to mouth breathing to the victims?

We do realize that we do not have proper medical ambulances or medical response teams, but why weren't medical teams mobilized from IGMH. IGMH has a protocol of responding to external emergencies by sending ER doctor and nurse to the site (even if  the protocol is poorly conceived and carried out at best).

If a common Emergency Service hotline was available, the person receiving the call could initiate and mobilize all these services almost instantly.

We are saddened that no person attempted CPR of any sort from the time the victims were removed from the well till they reached IGMH ER. The ambulances, even after knowing that they were responding to a life and death situation, left from IGMH with no equipment or medical personnel. Why?

The video footage shows ambulance drivers and attendants putting victims on IGMH ER beds and one doctor responding to another patient. Why weren't more doctors at the ER? In fact why weren't they or some of them waiting at the gate to receive the victim so as to initiate CPR early?

Common mans word against the MNDF and IGMH
We have seen one common man speaking on TVM saying that he was involved in reviving one patient, who he says was breathing when they reached IGMH. His words are contradicting what Dr Yasir said on TVM and what the MNDF Fire and Rescue service also revealed on TV. They both made inferences that victims were long dead before reaching IGMH.

This highlights the lack of proper medical intervention for the victims from the time of rescue till they reached IGMH. Had there been medical services or someone trained in CPR this may not have happened! We are not sure how effective the layman was in CPR, he has at least done something!


We believe this incident should be reviewed thoroughly and emergency services improved. We highlight these issue and believe these are thinking points:
  • Worker safety at all situation should be of prime importance. MNDF Fire and Rescue services could play a role in drawing up safety regulations with the Labour ministry. Especially in potentially troublesome work safety measures must be in place before hand.
  • We believe that a common Emergency Service needs to be established. This service should have an dedicated hotline (3 digit free number like 911, yes why not 911)  the number for which should be promoted by a campaign. The people manning the phone lines should be trained in extracting information from callers and if possible should have training that would enable them to advice the caller on immediate measure that could be taken. The caller then should initiate a multi-disciplinary emergency response (involving, where appropriate or in all cases Fire services, Rescue Services, Police services and Emergency Medical service). Emergency medical services should be included!
  • The rescue teams should be facilitated by the Police services in reaching the site without delay by clearing the roads. Public need to realize that impeding these services is punishable by law.
  • Until a proper Emergency Service is in place IGMH should utilize its external emergency response plan in assisting rescue missions with medical personnel and equipment. Ambulances responding to acute medical emergencies or incidents with potential acute emergencies should not leave the depot without medical personnel. Equipment should be ready for such dispatch and emergency medical officers ready and able to respond to such a need.
  • We believe that the medical response to the incident was a disaster. The lack of it is clearly evident on the video footage. IGMH, MNDF and MPS should jointly discuss the issue and identify how and who would be in-charge and running the medical services.
We also believe the families of the victims should be compensated for their loss. No amount of money would be enough, but some reasonable compensation would be useful. The employers who carried out the work should be involved in paying compensation.



Completely unrelated:
Update to newborn who nearly bled to death in Newborn ICU at IGMH: baby is doing well. She (not a he as previously reported) has come off mechanical respirator and is expected to do well.

60 comments:

Anonymous said...

This article has been written like a cock and bull story bordering onto tabloid journalism. The “light of your resident doctors medical knowledge” is missing in the article and the article can be regarded as a poor effort by your standards. MMW should realize that the strength of their articles lies in the accuracy of their information as well as the professional expertise they put in their articles.

Your article poses a lot of questions and no amicable solutions.

We do have an emergency medical system for bigger calamities and national emergencies like air port accidents. This accident as sad as it is cannot be called a national emergency. Yes it is the practice in other countries to have a single body for emergency services. What you fail to mention is that this body is usually the fire service. (Haven’t we seen enough of fire service people moving in 9/11 at world trade site? It wasn’t the New York Hospital staff). And they do have a single number which can be contacted with your phone even if you have no credit. And yes it is a three digit number. Not 911 as you propose but 119. Perhaps this number could have been disseminated more.

It’s the rescue team which is supposed to give emergency first aid. In all emergency services the shift is towards First aid. The amount of training the fire team from MNDF had in first aid is anybody’s guess. But if they have ambulances then………

I wonder why the person who took the phone from Police did not inform the necessary authorities…..

We must understand that emergency crowd control does not work as well as preplanned road blocks. So it is unfair to compare this incident with a presidential motorcade. And with the new found public freedom it’s a pride not to budge when authorities ask you to…….

About the layman seeing the man breathing till he reached IGMH, was the layman inside the ambulance?…highly unlikely. And if the delay had been more than thirty minutes as the article implies, without CPR, would the man really be breathing…. I guess all this is open to speculation….

From all the vedio footage looks like the cameras are faster than the stethoscopes ….

This is an unfortunate incident which happened to poor work safety and ill prepared emergency service and an irresponsible public. May be its not only IGMH, MPS and MNDF which should join in the discussion. This would involve public works, information (TVM and VOM), etc and maybe a concerted plan like what we have for national emergencies need to be drafted for small scale emergencies too…

Lets keep a minute of silence for all those who lost their live in this tragedy and hope that lives are not lost in vain. And hope some good will come out of this…. Lets us hope for some action and let not this be another futile debate in our parliament without any result.

virionx

Anonymous said...

Apparently the people who were drilling started on the project after seeing the movie " There will be Blood"

They thought that since the well looked blackish in colour, they might very well find OIL in the well and went after it just like in the movie.

Anonymous said...

stupidity has a price

Anonymous said...

As the people are already dead the last comment about drilling for oil is in poor taste...

Respect the dead for we will surely join them....

May their soul rest in peace

Virionx

Anonymous said...

MMW amaage fuye nukiya thibebala, kuraane kameh nethitha thi lhaa menna! faadu faadu kantha thakah boa nugalha, thilahla menge offeehuge nukurevi huri kantha kurevey tho balaa bala!

Anonymous said...

Somethings not matching here. Acoording to MNDF they got the phone call at 0129am and they were at the scene at 0137am (eight minutes) and the last person was taken out at 0207am.

Ref their website: http://mndf.gov.mv/

So where is the thirty minute delay becasue of the public MMW was talking about?

Like someone said above you are fast becoming a tabloid paper who is writing for the mass and not to reveal the truth.

Anonymous said...

ekkala MNDF ge aalaathun felenee mithanuga ves.

last anony, you believe MNDF version? keep kidding yourself.

listen to the 6th member of the work team on TV. He says the team arrived late! The 30 minutes is reported in the media not just by mmw.

virionx is it really 119? not 118? is there some confusion?

Anonymous said...

virionx, where is your solution? you have repeated exactly what mmw has said.

FIRE is 118!

Anonymous said...

We need a contigencies for accidents like these where by the relevant authorities can cordinate and work together. May be have point man in each department. Much like the national emergency plan where by the whole procedure including whom to call and the message to give is preplanned.


Yes fire is 118 not 119. (Thank you for correcting me). This could be a good starting point and they could have hotlines to other concerned authorities. This means someone senior and capable must man that line

The emergency crew needs more training in first aid. There was no excuse for them not starting CPR at the scene. My understanding is that a firstaider should continue first aid till a competent authority (doctor) declares death. So how could they not start CPR and assume the people to be dead. May be lack of training.......

Rescue teams need to improve their training, ie from MNDF to Police to ambulance staff in IGMH. Its time we divert from traditional doctor based systems to qualified paramedic based sytems as in most developed countries. After all this is the era of AEDs.

Most of all we must agree that there is a break down in the system and strive to improve it instead of running to save our asses.

virionx

JusticeLeague said...

This article is so difficult to read due to the differences in contrast of the text (black background with white text) and same size of the subheadings compared to the text.

It appears that MMW can see stories in black and white only. Use some colours to make things better.

Your site is like a cemetery.

justiceleague said...

I wonder if MMW's policy is to blame everybody except themselves whenever something goes wrong.

Too many speculations in your article. Speculations can be wrong.

Anonymous said...

exactly justiceleague

Too many speculations and assumptions.... hehe

virionx

Anonymous said...

After 30 years of leadership under H.E (MAG), we have vans that could as well be pick-up trucks for ambulances. The emergency training and simulation exercise carried out in 80s ended in disaster when vehicles crashed and doctors such as ND Abdulla were injured. After 30 years of progress under MAG, we don't even have a good Emergency and rescue Service. God Bless Maldives.

Anonymous said...

To be fair we do have a sort of a Emergency rescue service and disaster management protocol although it is not up mark.

And we have had many emergency training and simulation exercise carried since the 80s, although how much beneifit it provided is subject to speculation

virionx

venus said...

It is not his Excellency MAG, who will see to it that u get ambulance etc, for emergency management. It is our own maldivian doctors who should take intiative, to ask for the things they want,they require; rather than bitching about this and that, why not u all get together, and do something constructive.
Demand for it should come from the doctors, the hospital. Then see if it is not provided.
you doctors are the ppl who are educated in ur speciality and u all know what u wants.

Ask for the things u require, rather than saying. In Uk they have these things, we dont have it.. even in poor countries like Afganistan have it, but we dont have.. what did MAG do for us??? etc..

Anonymous said...

venus

I wish there were more of you in our administration

STOP CRIBBING, START ACTING

virionx

Anonymous said...

well doctors do ask for equipment but as alkways there are more pressing things like new building for office.. new tiles( which was changed only few months back)or some trip to go.or the admins think what we ask are frivolous or beyond the needs..so stop alwasy passing the buck to the doctor.yes we do know whats needed and if asked we do make lists and give. but what we get is nothing so yes we do stop bothering abt makin time to make those lists which go to dustbin.. for ex dont u think doctors must have begged for MRI/ working CT .. more monitoring devices

Anonymous said...

I though a lot of top brass starting from the deputy minister are doctors. Azee and Razee in the health ministry.

Even IGMH except for Alibe, everyone else seesm to be doctors. The Yasirs, FAs and Solihs etc...

Pity their collective wills and efforts are not amounting to anything.

I wonder which one of them is throwing the medical list into the dustbin? Or is MAG paying special attention to the health sector to make sure they are under equiped? Ridiculous

I wish that lack of equipements is the only problem in our health sector....

virionx

Anonymous said...

Record Medical Negligence Lawsuit Over Deaf Child
By Judith Evans in Malé
March 4, 2008

--------------------------------------------------------------------------------

The parents of a three-year-old girl who became deaf after a series of antibiotic injections at Thinadhoo Regional Hospital are suing the Ministry of Health for a record Rf 7.1 million.

A Malé doctor and several overseas paediatricians have told them the antibiotic was inappropriate in her case and was probably the cause of her hearing loss.

No help has been given to the family to deal with her condition since the child lost her hearing in July 2007, and only minimal assistance offered for her medical costs.

The Rf 7.1 million would pay for cochlear implants, the child’s only hope of regaining her hearing, along with six-monthly maintenance for the rest of her life and associated costs for travel and care.

Deafness

The child, now four, has suffered developmentally and emotionally since losing her hearing, says her father, Ahmed Ihusan of Gaaf Daal Fares. “She is not the same – she is always very angry now,” he says.

She was originally admitted to Thinadhoo Regional Hospital suffering a fever and a swollen arm in July 2007, after referral from the health centre on her island.

Paediatrician Dr Pawal recommended operating to remove pus from her arm. This was carried out on 14 July, though no pus was discovered during surgery.

On that day she was given two 80mg injections of the antibiotic Gentamycin, which is recommended only for specific, serious infections such as meningitis.

A third shot of Gentamycin was administered on 15 July, and a second operation carried out on 16 July.

Within four days, the child began complaining of a blockage in her ears, and tests found her to be completely deaf. She now does not speak, cannot attend school, and has suffered ongoing difficulties with balance.

Fight For Treatment

It was the start of a quest by the child’s parents to secure their daughter adequate care and treatment, in which the lawsuit is the latest move.

The suit follows a number of doctors confirming that her condition is directly related to the injections she received in hospital.

Dr Mauroof Hussein of Malé’s Indira Gandhi Memorial Hospital wrote after examination that the child had “developed sudden, profound nerve deafness of both ears, probably due to ototoxicity caused by Gentamycin (which is a commonly given antibiotic in high grade infections).”

Foreign specialists have since confirmed his judgement, the child’s parents say.

The parents have also sought help from the Ministry of Health, President’s Office and Department of Social Security.

But the Ministry of Health responded that the minister was too busy to assist, according to the parents; the President’s Office was unable to help and Social Security offered just one set of tickets to Trivandrum and US $300, a fraction of the funds required.

The relevant agencies could not confirm these details on Tuesday, saying they needed to check their records.

Meanwhile no specialist help has been made available to the family, which has subsequently spent Rf 300,000 on extended medical visits to India and Sri Lanka.

The Lawsuit

The child’s only hope of regaining her hearing is to undergo cochlear implants, specialists have said.

Represented by lawyer Husnu Suood on a pro bono basis, the family are suing the Health Ministry for medical costs so far; the cost of surgery, rehabilitation and maintenance of cochlear implants in both ears; psychological damage and future loss of earnings due to disability, totalling Rf 7.1 million.

The lawsuit says doctors at the hospital, who could not be reached for comment on Tuesday, administered an overdose of Gentomycin.

They also failed to check the child’s weight or the serum concentration in the injections, the suit alleges, plus the drug was inappropriate to her condition.

The civil case has been filed against the Ministry of Health because it administrates Thinadhoo Regional Hospital. It is the largest such case ever brought in Maldives.

“A previous medical negligence case, against IGMH, has been pending for two years,” Suood says. “We hope this will be dealt with much more quickly.”

Meanwhile the child’s family are appealing for donors to help with her immediate care and treatment. Anyone interesting in donating can contact minivan.news@gmail.com in the first instance.

xenon said...

THe current administration is not doing enough to improve the emergency medical services. Yes theres been some changes to the infrastructure of IGMH casualty but they have failed to realize the most important area which is human resource development. We dont have a single doctor or nurse trained in the field of Emergency Medicine. Infact Emergency Medicine is not even a priority in the training requirement list.
In the area of prehospital services our ambulances are not equipped to handle emergencies and there's absolutely nothing being done to train paramedics.
We need people with better visionery and capability to take over the policy level. The current doctors in the administration of helath sector has failed us miserably.

Anonymous said...

It is my understanding that training in emergency medicine is a priority and to this effect Dr Zeba is undergoing higher studies in Emergency Medicine in Malaysia...

virionx

Anonymous said...

Dr. Zebra ey. Stripes hureytha?

Anonymous said...

Hi, I agree with justice league...can you please change the white font color and black background, not so easy for the eyes. Dont wanna forgo sight for this website.
Interesting article. I have seen many perspectives in different blogs regarding this incident. Sad situation but shows the sorry state society is in. Everything in the end boils down to values.

Anonymous said...

Who is this f-----g Judith Evans posting a totally irrelevant comment here. What does she know about the medical services of Maldives or anything else for that matter.We donot need wise comments from such doubtful characters.
This is not the first such incidence in the Maldives.Industrial safety is given a back seat and no regulations have been put in place to date.It was utter stupidity to decend one by one into almost instant death and shows wide spread ignorance.The crowds as usual was a hindrance rather than of any real help.Human beings have a nature of getting fascinated over disaster, death etccc and this trait is perhaps more among the Maldivians.Many will gather around such places but few will be of any real help.
The police have later revealed carbon monoxide and hydrogen sulphide to be the gases present in the well causing these deaths.
However when did they take the gas samples?Was is an accurate estimate of the level of gases present during the actual scenario.
It is known that 12800 ppm(1.28%) in the breathing environment can cause unconsciousness after 2 to 3 breaths and death in less than 3 minutes.If the level of gas agt the actual time of death was this high could the emergency services be of any help? How long will it take the ambulance to reach the accident site in this case?can it come in less than 2 minutes or can the body be retrieved even faster than this?Even if the person has a lesser amount of exposure , the ideal place of treatment will be in a decompression chamber and in this case you have to head straight to Bandos Island Resort where the nearest decompression chamber is located but will they allow just any patient to be treated there since the cost of treatment in the chamber will easily reach 10000 dollars.

Anonymous said...

To avoid any confusion let me add that the gas mentioned above in the breathing environment is carbon monoxide.

Anonymous said...

It is easy to engage in mudslinging
without comprehending the realities but go onto the field and you will end up messing everything around without doing anything constructive.

Anonymous said...

Regarding Bandos chambers, they acyually do not refuse any patients. Countless maldivian divers who cannot pay have bee treated there after mishaps involving illegal diving for sea cucumber.

And to their credit places like ADK and Bandos do not refuse emergency patients regardless of their paying capanility.

But it would be necessary to make this into a law before some private sector refuses to give emergency treatment. Be proactive

Anonymous said...

ps..

Beside this is also the law in all other countries

virionx

Anonymous said...

A tragedy had happened
And all we could think of is bicker and blame each other
Now lets see the blame list

The five who died: For being stupid and reckless

The contractor: For not taking enough precaution

The Police: Failing in crowd control

MNDF: For reaching too late

IGMH: for being ill prepared

Construction Ministry: For not having enough laws to prevent this

Municipality: Inadequate supervision

Health Ministry: Moral responsibility for IGMH short comings

Government: Inadequate emergency management

MDP: For failing to do much as the largest opposition

Maumoon: He has to be in the list for sake of completion

Now lets see…What does that leave us with? Public for disrupting the rescue activity????

virionx

venus said...

lol Virionx, the part of Gayoom was the funniest.. haan he should be blamed too.. otherwise the blaming list wont be complete :P

justiceleague said...

MMW, I apologize for saying the site looks like a cemetary. I shouldn't have said it and regret saying it. Please accept my apology.

Like I said in the same comment, I still hope you will consider adding some pleasant colours to your site.

Anonymous said...

Perhaps the Bandos authorities may allow a poor chap to be treated in their decompression chamber but I doubt if this is same for the ADK hospital. They have a reputation for hoodwinking unsuspecting patients and siphoning all their money even if they dont have the means to treat the patient properly and by the time these poor patients or relatives get into their senses and go to a better hospital like IGMH or some of the hospitals in the neighbouring countries,they have no money left and almost beg from here and there for treatment.The money which they should have spend for their treatment is sucked in by a greedy hospital for doing numerous unnecessary investigations etc etcc. I wonder when the Maldivian public will wake up and realise that all that glitters is not gold and the hospital with the maximum Neon lights is actually not the place with the best doctors or the best treatment.

Anonymous said...

To the above anonymous:
'' I thought a lot of top brass from the deputy health minister are doctors, Dr Azee, Dr Razee etcc .....
Well honestly speaking you dont really know the mentality of people like Dr Azee who is in a position to do a lot of good but doesnot make any effort to do so.
Some of the doctors and the medical staff even call him '' DR NO'' .Not because he is some one as flamboyant as the Dr NO in the erstwhile James Bond movies but because of his negative attitudes and reputation for putting obstacles to so many progressive things that could have happened in the health sector.Unfortunately he still sits in the same office with same lopsided grin and make every effort to discourage any doctor who tries to improve things or do some good.

Anonymous said...

I find it hard to read as well. PLease change the background to normal white and black letters.

Anonymous said...

To the above anonymous:
All that glitters is not gold etc..
well this applies to the clinics too.Maldivians are fooled into thinking that the most colourful clinic or the one giving the maximum advertisement on the media has the best services.This is not the case and this pose a huge challenge to the patients to find who is the best doctor or the best clinic.''Good wine need no advertisement'' This applies very well here too.The best doctors are most of the time unassuming and it is their tract record of service that will clinch them most of the time.How satisfied the patients are on numerous occasions etcc etcc and such news spread by word of mouth as first hand experience from satisfied clients.Some patients are more lucky that they find their ideal doctors earlier than others.The most unfortunate will waste a lot of time and money before they get the doctor of their choice who will be genuinely concerned with their welfare and is technically competent and is not so greedy by nature.However in a small place like Male or the Maldives this is not that difficult too because the public will come to know about the few Maldivian or foreign doctors in no time.

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