Response of Hospitals to the Terror Attacks

Mass casualty incidents often put health systems under a tremendous resource crunch in terms of equipment, adequate staffing and resources. Documentation and research related to such events is critical in policy-making and planning of hospital preparedness. During the 2008 Mumbai Terror Attacks, which left 172 dead and 304 injured the hospitals that responded were the state-run JJ Hospital and its peripheral hospitals: G.T Hospital and St. George’s Hospital. In addition the Cama and Albless Hospital itself was under attack, which created a challenging situation for the staff where they had to also ensure safety of patients and themselves. The unprecedented nature and the duration of the attacks further complicated the chaotic atmosphere in which the hospitals had to operate. This study by CEHAT in collaboration with the Tata Institute of Social Sciences (TISS), Mumbai aimed to understand how these public hospitals responded to the attacks and assess the preparedness of the hospitals to deal with such a crisis from the healthcare providers’ perspective. Moreover, it attempted to document lessons learnt and identified ways of improving the response based on experiences of the providers. The study used in-depth interviews of staff in the four hospitals present during attacks regarding detailed accounts of interaction within and outside the hospitals, constraints faced and recommendations for measures to be taken ensuring efficiency. It is hoped that this study can be a key resource for policy makers and hospital administrators in the preparation and training of health care providers to respond to such events. It stresses for looking at medical interventions during emergencies in the Indian context so that best practices can be recognized and formed into new plans or codified into the existing plans. This study intends to enable the public health system to move from impulsive reaction to proactive response.

Findings:

• The study showed that the existing emergency plans at the hospital and city-level were insufficient to meet with pressures and challenges of responding during the attack and should therefore these plans should be made more comprehensive by assessing vulnerabilities and preventive actions.

• There is a need to create standardised protocols and procedures to be followed by the various responding agencies during mass emergency to prevent duplication of resources and time delays.

• The study highlighted that conducting regular trainings and drills of the hospital staff co-ordinating both within and outside the hospital and between agencies can streamline the process of responding to emergencies.

• The provision of systematic psychosocial support for those affected including healthcare providers working during emergencies is an area that needs to be critically looked at.

• There is a need for better communication and co-ordination between hospitals and various agencies like the government, police, media and voluntary organizations to minimize gaps and respond to terrorist-attacks during mass-emergencies.

• The study emphasizes that mass casualties maybe unpredictable but good planning that allows scaling up and incorporates multi-sectoral involvement can drastically improve the response.

Team: Siddarth David, Sana Contractor, Anita Jain, Nidhi Sharma, Padma Deosthali