Descriptive analysis and lessons learned from the disaster medical response to an urban building collapse

Abstract

An effective disaster medical response plan is imperative for any established emergency medicine program. Here we describe the response to an urban building collapse in Dar es Salaam, Tanzania, including a description of the event, type and severity of casualties, and lessons learned. We interviewed members of the medical response team and reviewed the treatment records and the results of the investigation. Several local hospitals sent personnel to assist at the site. The Muhimbili National Hospital Emergency Department (ED) sent staff to establish triage and provide stabilizing medical care, while another team remained in the ED and prepared to treat survivors. Of fifty nine casualties, 37 were dead at the scene. The most common injuries among the survivors were musculoskeletal and soft tissue trauma, including fractures, lacerations, and degloving injuries. All were stabilized on-site prior to transport to the hospital. The search and rescue efforts were hampered by a lack of resources. Heavy machinery, sufficient to clear the rubble and facilitate rescue efforts, was not immediately available. Private engineering companies later provided this equipment. Protective gear, such as hard hats, gloves, and boots were not available, thus some responders were injured while clearing the rubble and three were bitten by police dogs. Family members gathered at the scene to await news of survivors and some developed respiratory distress due to the dusty environment while others syncopized. The investigation revealed that the building was licensed for 10 floors, but construction continued illegally to 16 floors. Structural factors contributing to the collapse included poorly mixed concrete and substandard steel bars. This event highlights the importance of a well-developed disaster response plan, including coordination of medical and rescue workers. Additional policy and advocacy issues identified include the need for building safety code enforcement and available rescue supplies, equipment, and machinery.