Rescue Emergency I need a simple PPT on this PDF with speaker notes Hindawi Publishing Corporation e Scientific World Journal Volume 2015, Article ID 13643

Rescue Emergency I need a simple PPT on this PDF with speaker notes Hindawi Publishing Corporation
e Scientific World Journal
Volume 2015, Article ID 136434, 8 pages
http://dx.doi.org/10.1155/2015/136434
Research Article
Rescue and Emergency Management of a Man-Made Disaster:
Lesson Learnt from a Collapse Factory Building, Bangladesh
Animesh Biswas,1,2 Aminur Rahman,1 Saidur Rahman Mashreky,1
Tasnuva Humaira,1 and Koustuv Dalal2
1
Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
Centre for Injury Prevention and Safety Promotion, Department of Public Health Sciences, School of Health and Medical Sciences,
Örebro University, 701 82 Örebro, Sweden
2
Correspondence should be addressed to Animesh Biswas; agni72001@yahoo.com
Received 18 July 2014; Revised 20 February 2015; Accepted 2 March 2015
Academic Editor: Jochen Hinkelbein
Copyright © 2015 Animesh Biswas et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
A tragic disaster occurred on April 24, 2013, in Bangladesh, when a nine storied building in a suburban area collapsed and killed 1115
people and injured many more. The study describes the process of rescue operation and emergency management services provided
in the event. Data were collected using qualitative methods including in-depth interviews and a focus group discussion with the
involved medical students, doctors, volunteers, and local people. Immediately after the disaster, rescue teams came to the place
from Bangladesh Armed Forces, Bangladesh Navy, Bangladesh Air Force, and Dhaka Metropolitan and local Police and doctors,
medical students, and nurses from nearby medical college hospitals and private hospitals and students from colleges and universities
including local civil people. Doctors and medical students provided 24-hour services at the disaster place and in hospitals. Minor
injured patients were treated at health camps and major injured patients were immediately carried to nearby hospital. Despite the
limitations of a low resource setting, Bangladesh faced a tremendous challenge to manage the man-made disaster and experienced
enormous support from different sectors of society to manage the disaster carefully and saved thousands of lives. This effort could
help to develop a standard emergency management system applicable to Bangladesh and other counties with similar settings.
1. Introduction
Building collapses are a major cause of mortality and morbidity around the world. In the last decade, a number of
buildings have collapsed causing a significant number of
deaths and illness. In recent years, high and middle income
countries like USA, South Korea, Turkey, Austria, and China
have experienced disasters due to collapsed buildings [1–6].
In New work City, six people were killed and more than 20
were injured in two residential buildings which collapsed
due to gas explosion [1]. Another six people were injured
in a building site collapse at the new Turkish railway in
May 2014 [2]. North Korea faced a 23 storied residential
building collapse and in South Korea there was also a similar
type of building collapse, which killed 10 people including
nine university students with many more [2, 3]. India has
experienced a number of recent deadly building collapse
disasters. During 2014, the country had two major building
disasters, which occurred in Mumbai in April 2014 killing
45 people including 15 children and another 70 people were
injured in the incident [7]. Similarly, Bangladesh has also
experienced such man-made disasters during the last decade,
which have caused a large number deaths and injuries.
On April 24, 2013, a nine-story building named Rana
Plaza situated at Savar subdistrict in Dhaka suddenly collapsed around 9 o’clock in the morning (Figure 3). The
building contained four garment industries, a bank, apartments, and several other shops. This man-made disaster
caused a massive loss of human and material, economic, and
environmental loss. Although Bangladesh has experienced
similar disasters previously, no other such disasters were so
serious considering the death toll. It has been considered
to be the deadliest garment-factory collapse in the history
of Bangladesh, as well as the deadliest accidental structural
failure in modern human history [8]. Local volunteers with
the help of the trained forces were deployed to rescue the
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victims, whether dead or alive (Figure 4). Unsafe human act
took this greatest toll, but the same mankind came forward
to save hundreds of lives from the terrible event. This paper
explores how the rescue process took place and the initial
emergency medical management of the victims at the event
by trained forces and untrained community rescuers and its
lesson learnt.
2. Materials and Methods
2.1. Location of the Disaster. Savar, a subdistrict, is located
about 25 kilometers northwest of the capital city Dhaka,
Bangladesh. It has a population of over 13 million. The
subdistrict has an industrial importance, particularly due
to the presence of garments industries. Garment industries
are widely located and many thousands of people in the
workforce earn their livelihood by their hard work in these
industries. The subdistrict is well connected with Dhaka by
road. There is one military cantonment, one public university,
and two private medical college hospitals with good health
facilities [9].
2.2. Gathering Information. We deployed the following techniques to gather relevant information related to rescue and
emergency management:
(i) reviewing printed and electronic media reports
including newspaper and television coverage;
(ii) in-depth interviews with the rescuers and personnel
involved in emergency medical management;
(iii) focus group discussions (FGD) with undergraduate
medical students who assisted in emergency management.
2.2.1. Reviewing Print and Electronic Media Reports. After the
event, we reviewed five daily popular local language (Bengali)
and three English newspapers from April 24, 2013, to the
end of rescue operation, May 13, 2013. We also followed the
news of electronic media (television) to get information and
updates of the events and noted the relevant information.
2.2.2. In-Depth Interviews. To gain deeper understanding
we performed in-depth interviews (IDIs) with different
personnel. We have performed in-depth interviews (IDIs)
with different personnel who were directly involved in rescue
and emergency medical management immediately after the
event. The interviewees were with two medical doctors, two
scout volunteers, and two local untrained volunteers. The indepth interviews were conducted over the telephone and each
interview took around 20–30 minutes. The interviews were
conducted by an anthropologist within the research team.
2.2.3. Focus Group Discussions. Moreover, one focus group
discussion (FGD) was conducted with seven undergraduate
medical students studying in a private medical college named
Gonoshasthaya Samaj Vittik Medical College situated in the
subdistrict. These students assisted in emergency management of the victims in the health camp at the scene (Figure 5).
The FGD was organized at the medical college on May 20,
2013. The discussion continued for about 90 minutes. The
interviewing team consisted of a public-health specialist and
a facilitator.
2.3. Checklist for IDIs and FGD. A semistructured checklist
was developed and used to conduct IDIs and the FGD. In the
checklist seven thematic areas of discussion were identified,
which included understanding of the event, initiation of the
emergency management, engagement of the media, referral
of the injured victims, hospital administrators response to the
disaster, challenges encountered during emergency management, and finally the effectiveness and achievement of the
emergency management. To explore each of the discussion
areas, several prompts were used (Table 1).
2.4. Data Collection and Analysis. In case of IDIs the telephone interviews were audio-recorded with prior permission
from the interviewees and hand notes were taken for some of
the thematic areas during the telephonic conversation. The
facilitator of the FGD session used prompts to explore the
desired information, and similar to the IDIs this session was
also audio-taped with the respondents’ permission.
After the interviews and discussion, a two-member team
under the guidance of the researchers prepared Bengali
transcripts of the audio records. Then the transcripts were
translated into English.
The analysis was done by examining the transcripts and
note-taker’s notes in detail to identify the range of ways
in which the participants responded to various prompts.
Thematic analysis was performed for FGD and IDIs whereas
content analysis was made for analyzing electronic and
printing media news.
3. Results
We have designed the Results section according to the areas
that we identified for the IDIs, and FGD and content analysis
from the media has also been incorporated.
3.1. Extent of Damage. Media reports revealed that the Rana
Plaza, a nine storied building that housed four garment
factories, a bank branch, and several general shops, collapsed
at 9 a.m. on April 24, 2013. The garments factories were
opened on their regular working hour at 8 o’clock in the
morning. All the workers of the garment factories and general
shops started their regular work in the building. All the
machines and generators were switched on. Suddenly, pillars
of the building collapsed and the roofs from the top to the
bottom floors fell one upon another. Concrete pillars of every
shape dangled precariously, ready to snap, and crashed down.
Various media reported that the day before the event it was
noticed that there were a number of cracks in pillars; however,
the building’s safety was assured by its owner.
Regarding building collapse one of the volunteers who
participated in IDI narrated:
The building (Rana Plaza) collapsed all on a sudden after a big bang around 9.00 a.m. . .hundreds
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Table 1: Checklist for IDIs and FGD.
Qualitative method used and group of the
participants with age range
Area of discussion
Prompt used
Extent of damage
Initiation of rescue and emergency
management
Engagement of media
(1) FGD ( aged 21–25 years), 7 persons
Medical students
(2) IDI (25 yrs–45 yrs )
Medical doctor, volunteer, general people
Referral of the injured patients
Disaster response of the hospital
administrators
Challenges during emergency
management
Strength and achievement of
emergency management
(i) What happened?
(ii) How did it happen?
(iii) What was level of damage?
(i) How were rescue and emergency management
initiated?
(ii) Who were involved?
(i) How did media act?
(ii) What was the impact of media on people?
(i) What was the process to referral system?
(ii) How were the patients transferred?
(iii) Who were involved in the process?
(iv) What was the role of different people involved
in the process?
(i) What was the preparedness at the hospital?
(ii) How were hospital administrators acting?
(i) What were the challenges faced during rescue
and emergency medical management?
(i) What were the strengths?
(ii) What were the achievements noted?
(iii) Is there any success stories?
of people died instantly; thousands injured, many
of them trapped inside the collapse building alive.
Another volunteer narrated his experiences in IDI:
I have seen most of the floors of the building
collapsed and. . .gaps between each of the roof of
different floors looked no more than two feet.
The nine storied building became three storied
in height. . .No one could estimate actually how
many people were trapped inside. . .we were so
shocked to see this.
Fire
brigade
National
defense
forces
Politicians
3.2. Initiation of Rescue and Emergency Medical Management.
As reported by different media, the Fire Service and Civil
Defense (public fire-fighting authority) arrived at the scene
within 30 minutes. Local people also came forward hearing
the call for help by the victims who were trapped in the
collapsed building. Fire Service and Civil Defense personnel
with the help of local people rescued the first person within
30 minutes of the event. Immediately after the collapse other
agencies including Police, Rapid Action Battalion (a special
force of a combination of military and police personnel),
Bangladesh Armed Forces, and Ansar (an aid to regular
police force) came to the scene to help. At the beginning
of the rescue process, about 200 Fire Service and Civil
Defense personnel and around 200 local people participated
in the rescue process. Several private ambulance services sent
their ambulances voluntarily for transportation of victims
to the nearby hospitals. Doctors and undergraduate medical
students of different medical colleges of the locality arrived
at the scene and set up medical camps to provide emergency
services to the victims. Every few minutes for the first few
hours of the disaster, seriously injured patients were rescued
and emergency care was given by the medical teams at the
Civil people
Media
Doctors
A nine storied building
collapse with about 5000
indwellers
Social
organization
Professional
rescuer
Students/
medical
students
Figure 1: Responses just after the Savar disaster occurred.
camps. They were then carried to the nearby hospitals for
further management. Red Crescent and volunteers from different organizations brought the patients from the damaged
building to the health camps. Some victims were directly
sent to the health facilities after the local people rescued
them. Some volunteers and law enforcing agencies cleared the
highway for immediate transfer of the patients (Figure 1).
A medical student that worked in the health camp
described the following:
When we came about an hour later, we saw that in
every few minutes a trapped person is pulled out
and rushed to the hospital in an ambulance or in
microbus.
One of the medical students who worked in the health camp
narrated:
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We set-up our health camp within an hour (after
the disaster). At the beginning, we were not prepared much, but we tried to treat minor injuries,
the majority of casualties were directly sent to a
nearby private hospital.
One local volunteer described the following:
Just after the incident, we tried to rescue people
from inside the collapsed building and if we saw
any person with blood shedding or broken leg or
hand, we put them on the patient trolley. . .and
people waiting outside took the victims immediately to the hospital. Many of the victims were even
taken to the hospital by motorcycles of the local
people.
Govt. primary
health care center
Patients
rescued
Primary care given
at health camp
Recovered after
receiving primary
treatment
Private medical
College hospital
Govt. medical
College hospital
Specialized hospital
Figure 2: Referral system practiced during the Savar disaster.
Another volunteer reported the following during his IDI:
Bangladesh Army and police were handling the
transferring patients with the support of the local
people. There was minimum delay in transferring
patients just after rescuing from the building.
3.3. Engagement of Media. Media played a crucial role after
the disaster. National TV channels including Bangladesh
Television (BTV) and around 12 private TV channels, government radio station Bangladesh Betar, and FM stations started
broadcasting live news from the start of the tragic event.
Private TV channels scrolled the breaking news and special
news was telecasted at regular intervals. A number of TV
channels live telecasted from the spot the whole day. Media
helped a lot to inform the relatives of those who worked in
that building and many of the relatives started to come to
Dhaka from villages just after getting information.
During an interview a doctor said:
We took support from them to let the blood donor
come to donate blood. We had requirement of
thousands bags of blood and some of those had
rare negative groups.
One volunteer said during IDI:
I saw the disaster event in television channel; my
home is about 100 kilometers from the disaster
place. As soon I get the information, me and two
of my friends decided to come to the place and help
in the rescuing.
The story of one person who came from a rural village
mentioned that he had come from north Bengal, which is
about 180 kilometers from the disaster site. He saw that many
people were coming to help the victims and rescuers by
providing medicines, food, water, and so forth. He collected
bananas from his own banana tree and bought packets of
bread and caught a bus to Savar, which took about seven
hours.
Another doctor mentioned that he found that a number
of negative blood bags had been collected in the blood donation camp. The need for rare blood groups was transmitted by
the television channels.
Figure 3: What happened after Rana Plaza collapsed.
Due to the continuous news updates, many people started
to come to the place to help and join the rescue process. Like
this, many people also provided support and aid by knowing
the facts through live telecasts and radio news updates.
Moreover, the printed media detailed the entire situation
including regular updates on how many people were rescued,
how many were still missing, and how many of them had
already died. People also read that news from newspapers and
came to help the injured people. A few printed newspapers
started a fund for the victims and many people donated
money to the newspapers’ bank account.
3.4. Referral System of the Patients. Victims rescued from the
disaster were primarily treated just outside of the collapsed
building. There were two health camps engaged in providing
24-hour first aid treatment. Minor cut injuries were managed
locally and released after initial treatment given at the
center. Each of the health camps was equipped with first
aid medicines and instruments. Doctors were responsible for
immediately diagnosing the severity of the condition of the
injured and referred to the appropriate health care facilities.
However, some patients were directly transferred to referral
centers without treatment from the health camps because of
the degree of severity (Figure 2).
During in-depth interviews, one doctor who worked in
the health camp mentioned the following:
We provided initial treatment, many patients
come to us with cut injuries, we cleaned the wound
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I never faced such conditions, patients were coming in every minute, lots of people were coming
with patients. We don’t have such emergency
management system in the hospital but we are
committed to tried at best level to manage such
condition, our all operation theaters were in
action 24 hours.
A university student who volunteers on behalf of Bangladesh
Scouts described the following:
Figure 4: Rescue at Rana Plaza collapse.
Figure 5: Treatment at make-shift camp after Rana Plaza collapsed.
and put bandage. We also found huge number
of patients with fractures; we provided first aid
of fracture and referred them to the hospital
immediately.
He added
We treated not only the people trapped in that
building but also the rescuers who became sick
during the rescuing. They had dehydration and
became injured.
During the FGD a medical student working at that health
camp reported:
We didn’t have any referral form or structured
documents, our seniors examined the patients and
if it was required to transfer to higher center immediately, local people or fire brigade or armed
force brought them by ambulance.
The general people engaged in the recue process mentioned
the following:
We can guess which patients were required to
send to hospital directly because many of patients
had cut their limbs during rescuing and had
severe bleeding, they were transferred immediate…
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