35 CASUALTY CLEARANCE - BMJ Military Health · combined St. John-Red Cross seminar was held in...

35

CASUALTY CLEARANCE EXPERIENCES AT THE KENYA INDEPENDENCE

CELEBRATIONS .

Captain W. E. I. FORSYTHE-JAUCH M.A., M.B., B.Chir., M.R.C.S., L.R.C.P., R.A.M.C.

Lieutenant-Colonel R. G. ROBINSON, M.B., Ch.B., D.T.M. & H., R.A.M.C.

24 Field Ambulance '

Introduction KENYA, after nearly 70 years of British rule, became an independent nation on the night of 11th-12th December, 1963. Approximately 500,000 people attended the celebrations and during 48 hours at the Independel,1ce Stadium, Nairobi, 932 casualties occurred. This is an account of how the disposal of casualties was arranged, with a summary of types of casualty treated.

The Kenya Ministry of Health requested the St. John Ambulance Brigade, N airo bi, to make preparations for the treatment of casualties expected at the Independence Celebrations in Deceinber. However, it was not long before it became obvious that this. problem was more than the St. John Ambulance Brigade could deal with, therefore a committee was formed under the chairmanship of the acting Deputy Director of Medical Services to delegate responsibility as follows:

Ministry of Health/Director of Medical Services I

I I Co-ordinator of Medical Services at the Independence Stadium

(Medical Superintendent King GeorgeVI Hospital) Public Health Dept.

I St. John Ambulance Brigade

(Capt. Forsythe-Jauch) r I

Stretcher-Bearer Parties

I I

Field Hospital Maternity Unit (Lt.-Col. Robinson) (Mrs. Vickers & Major Peacock)

I First-Aid Posts

The Field of Operations The Uhuru (Swahili for "Freedom':) Stadium was built on the south side of the

Nairobi-Langata Road, about five miles from Nairobi. This is a narrow road allowing a single line of traffic in each direction;. however, there is another route into Nairobi going in a full circle through a suburb, a journey of about 17 miles. The advantages of this site were that it used to be waste land, that it is shaped like a natural amphitheatre and is close to Langata Barracks (3rd Bn., The King's African Rifles, now the 3rd Bn., The KehyaRifles).

The Uhuru Stadium is in three parts (Fig. I). A block of 20,000 seats including the Royal Box, a similar block opposite it, and on the gently sloping hillside standing space for-200,000 to 300,000 people, thus forming three sides of a square. The fourth side was for the-flag ceremonies, fireworks, etc. The seated blocks had gangways and the standing space was intersected with crush barriers and gangways. Access to the

by guest. Protected by copyright.

on Novem

ber 21, 2020http://m

ilitaryhealth.bmj.com

/J R

Arm

y Med C

orps: first published as 10.1136/jramc-110-01-11 on 1 January 1964. D

ownloaded from

http://militaryhealth.bmj.com/

36 Casualty Clearance

road from the Stadium was by paths large enough for ambulances, but with one-way traffic only. Langata Barracks are about half a mile away, with a fenced~off area of playing fields between. There is a dirt path between the barracks and playing fields, and a road was built between the playing fields and the Stadium.

Initial Problems An initial problem was that of forecasting possible casualties. Other countries

which had recently become independent were approached, but these supplied either figures which were of little value or no 'figures at all. For example, one stated that to all intents and purposes there were no casualties and could not be. more specific; another gave a figure which would have given a forecast of 350-500 casualties in our expected crowd of 500,000 but said that many of their casualties had not been recorded. It would have been extremely useful to have had an accurate forecast of delivery of babies. During the Uganda celebrations in a crowd of 70,000 there were no deliveries or miscarriages reported to the medical authorities; on the other hand, at an upcountry polling station during the Kenya elections, where there was a day-long queue of 2,000 people, the police delivered 12 babies. The birth-rate figure in Kenya was of no value, .as pregnant mothers would often have travelled great distances by foot and by bus, there by precipitating labour. The end of the second week in December coincides with the end of the short rains in Nairobi. The weather might therefore be either

,dry, dusty and very hot with mild nights, humid ang. mild day and night, or heavy rain with cold nights. With such variants, no long-range weather forecast could be of much value in estimating heat-illness figures.

Poor road access to the Stadium would make it extremely difficult to evacuate patients by road. Mor,eover it could be expected that roads would be blocked by pedestrians; as the 100,000 or so Africans living within a' 30 miles radius of Nairobi would probably walk in. The rest of the public would travel by buses which, belonging to private firms, ate notoriously liable to break down and cause traffic blocks.

The last problem, other than staff, was that which might result from the sale of beer. Unlike the celebrations in other East African territories which were "dry," beer was to be sold at kiosks. A drunk African is not normally violent, but tribal animosities are never far below the surface in Kenya: and might well be expected to cause problems.

, Planning Not knowing what of medical significance might happen during the Celebrations

it was decided to plan the evacuatio:Q. scheme as lavishly as possible and the plan was as follows:

(1) Stretcher-Bearer Parties in the Stadium would either treat on the spot or

(2)

(3)

evacuate to First Aid Posts on the periphery of the Stadium for treatment or further evacuation to either Field Hospital in Langata Barracks Playing Fields

or (4) Maternity Unit, the Medical Reception Station in

Langata Barracks. }

I for treatment, holding or evacuation


on Novem



/J R

Arm

y Med C


ownloaded from


W. E. I. Forsythe-Jauch and R. G. Robinson 37

The Stadium Services

(a) Stretcher-Bearer Parties consisting of four St. John Ambulance Adult FirstAid Certificate holders, commanded by a St. John N.C.O., were deployed in the Stadium area. Each group of four stretcher-bearer parties was attached to a parent First-Aid Post and had a specific area of Stadium "(:6verage. At the actual time of Independence, 40 stretcher-bearer parties ,were deployed, but for the remainder of the 36 hours during which the Stadium was medically covered the parties worked on a roster, with the number of parties scaled to suit the smaller crowds. In November a combined St. John-Red Cross seminar was held in which special training was given to the stretcher-bearers. Special emphasis was laid on the treatment of bleeding, asphyxia, shock, crush injuries and burns (from .fireworks), with stretcher drill including the technique of lifting stretchers over people and crush barriers. Apart from major first-aid, teaching was given in treating minor injuries in the Stadium without recourse to the first-aid post.

(b) First-Aid Posts. Four first-aid posts were built, each equipped with electric light, paraffin sterilizers, running water and telephone with internal connections to Field Hospital, Maternity Unit and Ambulance Park, etc. Though not ideal in size or appointments they were built and sited to fit in with the general structural plan of the Stadium. Drugs and equipment were obtained on loan from the Kenya Government Medical Stores., Drugs were necessarily of a fairly simple nature for first-aid only. There were three departures from what is usually considered first-aid equipment, Le., suturing material, intravenous dextram and a small selection of emergency drugs, viz. aminophylline, morphine, corarnine and snakebite antivenene.

(c) Staffing of the First-Aid Posts: (i) Doctors. Twenty-two doctors volunteered their services through the Kenya

Medical Association and other organizations. A roster was arranged in which one doctor was on duty for the Stadium the whole time, with more on duty at the busiest times.

(ii) Nurses. The St. John Ambulance Nursing Divisions supplied it roster of nurses.: These were all qualified in first-aid, some in home nursing, others were K.R.N. (Kenya Registered Nurses) and some S.R.N.

(iii) Ambulance Men. Three men of the European and Asian Division of the St. John Ambulance Brigade were on duty on a roster at each First-Aid Post. One of these acted as a clerk and general handyman giving out food and tea. As well as the three on duty there was an off-duty Stretcher-Bearer Party at the First-Aid Post, usually resting and eating but helping if needed.

(iv) Ambulances and Drivers. One ambulance with driver was attached to each First-Aid 'Post (these were St. John vehicles).

Stadium Administration . At the busiest time about 350 people were on medical duty in the Stadium. It could

be justifiably said that this number was not strictly necessary; however, at the actual hour of independence, preceded by tribal dancing; a military tattoo, the ceremonies and fireworks display, no Kenyan would wish to be absent! It was felt that officers


on Novem



/J R

Arm

y Med C


ownloaded from


38 Casually Clearance

Kenya '"dependence Celebrations


on Novem



/J R

Arm

y Med C


ownloaded from



should be in overall charge of the medical services; therefore senior St. John Ambulance Officers, termed "Duty Officers" and Junior St. John: Ambulance Officers, termed "Assistant Duty Officers," served on a roster basis. Duty Officers' responsibilities were for the medical arrangements in shifts of six hours. This included liaison with doctors, police, press, visiting V.LPs., the Maternity Unit and Field Hospital. It was his duty to meet and dismiss all staff, directing them to t~eir stations. He was assisted by two Assistant Duty Officers. Assistant Duty Officers' responsibilities were, to gt:nerally look after staff, their work and comfort, supervise documentation, checking equipment and drug stocks at the end of their tour of duty.

All staff were transported from their homes to St. John House and from there to ,the Uhuru Stadium in either a 60-seater bus or a 12-seater minibus, which were on loan from the Government. Travelling was done at "off-peak" times, when events were in progress and there was the best chance of the bus getting through., Each stretcher-bearer was provided with Ss. per duty to buy his food at the kiosks in the Stadium area. For the nurses, doctors and officers, food of a buffet type was brought to the Stadium. Anelectric refrigerator was installed and primus stove cooking by the nurses provided fried eggs and bacon for breakfast. .

The Maternity Unit

The Medical Reception Station at Langata Barracks was made available for this. Though normally holding 30 beds, a total of 60 beds was equipped and two labour wards were prepared. Teams' of Red Cross V.A.D. were on duty under the supervision of Mrs. J. C. Vickers, S.R.N., S;C.M., of the Kenya Red Cross, with Major G. W. Peacock, M.A., M.R.C.S., L.R.C.P., D.R.C.O.G., D.T.M. & H., 24 Field Ambulance R.A.M.C., as Medical Officer on call. The Red Cross workers lived in marquees in Langata Barracks and cooking facilities were provided by Kenya Girl Guides.

The Field . Hospital

Military medical assistance was requested to hold patients from the time at which the roads to the Stadium became impassable to outbound traffic, until they became passable again, and to retain suitable minor cases whose transfer to King George VI (Government) Hospital was considered unnecessary. It was decided to locate this organization in the 3rd King's African Rifles Sports Stadium which lay close to, but out of view of, the Uhuru Stadium. As its function was not equivalent to that of any unit in the military chain of evacuation it was labelled "Field Hospital." Originally it was hoped to staff the Field Hospital with soldiers from 70 Brigade Medical Company reinforced by an administrative element and medical officers from 24 Field Ambulance. Later, operational considerations prevented the full participation of 70 Brigade Group Medical Company,and the staff of the Field Hospital finished up

. by being predominantly from 24 Field Ambulance with comparatively small reinforcement parties from 70 Brigade Medical Company (1 warrant officer, 3 corporals and 13 privates), King George VI Hospital (1 medical officer and 6 dressers) and British Military Hospital, Nairobi (5 dressers).


on Novem



/J R

Arm

y Med C


ownloaded from



Functionally the hospital consisted of: (a) Command Post (Hospital Office). (b) Reception and Treatment Departments. (c) Wards: (i) 50 female beds and children's cots.

(ii) 25 male beds. (iii) Male and female sitting patients' wards.

(d) Q.M., Messes, etc.

}

capable of crisis expansion to 100 beds plus cots.

There were two blocks of latrines with water-borne sanitation in the Stadium which were suitably sited for patients and staff respectively. The bulk of the medical equipment came from Government Medical Stores and most of the ordnance equipment from Army sources. 24 Field Ambulance supplied as little as possible so as not to prejudice its operational readiness.

In addition to the duties associated with their appointments, the Second-inCommand acted as registrar, obstetrician and gynrecologist to the Maternity Unit, and the Motor Transport Officer was responsible for lighting and fire precautions.

A time-table for the erection, equipping, running and run-down of the Hospital was drawn up for guidance. Helicopter landing zones were investigated at Field Hospital (day and night); at 3 K.A.R. parade ground for Maternity Unit (day only); at King George VI Hospital (day only); at Pumwani Maternity Hospital (day only). NIGHT evacuation was to base at R.A.F. Eastleigh.

The project progressed as follows:-18th November D.M.S. (Civil) Conference. 25th November Commanding Officer's "0" Group. 2nd December Erecting tentage began. 6th December Hospital fully equipped.

10th December 2200 hours. First Patient admitted. 11th December 1000 hours. Hospital officially open to receive casualties. 12th December 1700 hours. Last patient admitted. 12th December 2359 hours. Hospital closed for admissions. 13th December 0900 hours. Last patient discharged home.

Occurrences of interest included the admission of a female "tribal dancer" with a fractured patella and the evacuation in a helicopter by night of a patient whose uterine inertia had led to fretal distress. This was at a time when all the access roads were choked with traffic. Among the lessons learned during the operation were the facts that wooden duck-boards and tent floors are essential for clinical departments and the time spent in choosing and laying out night helicopter landing zones is very well worth while.

The plan of the Field Hospital is shown in Fig. 2. During the time the Hospital was open 18 patients were seen of which nine were detained. The small numbers were probably due to the rains which had caused flooding of rivers in the Reserves and thus kept away many of the very young and very old from whom it had been thought that the majority of cases would come. The crowd behaved in an extremely peaceful manner. There were no fights, no cases of wounding and only six cases bf drunkenness. The, weather was mild and humid with the sun breaking through the clouds at midday on both 11th and 12th December.


on Novem



/J R

Arm

y Med C


ownloaded from


W. E. /. Forsythe-Jauch and R. G. Robinson 41

Kenya Independence Celehratiolfs


on Novem



/J R

Arm

y Med C


ownloaded from



. . Th.e Working of the Plan . As is well known to most members of the Corps, the medical plan may function

perfectly and then transport will provide all the worries or vice versa. Here was no exception. The bus driver who had contracted to,collect the stretcher-bearers from. theii: homes, celebrated his own Independence by disappearing complete with bus. For-

lANGATA BARRACKS

.3 KENYA RIFlES.

RDADS PASSABLE FOR AMBUI.ANCES.

F.A.P. First-aid Post

Figure 1. The Uhuru Stadium

ODD r=:J S7AFF

CDDKHtJU.lE ---

'HElICOPTFII

LANDING

ZO~E

STAFF lATRINE

.oa M[J

CAll PAIII(

ENTRANCE

A.O.R.

Q.M.

B.O.R.

African Other Ranks

Quartermaster

British Other Ranks

M.T. Motor Transport

C.P. Command Post

Figure 2. The,iField Hospital"

tunately it was possible to make other arrangements, retiming all other transport with little delay. Communication with the Field Hospital was hampered by the special connecting road becoming impassable because of mud, but casualties were evacuated satisfactorily through the crowd to the main road and then to the Field Hospital. It


on Novem



/J R

Arm

y Med C


ownloaded from



would have been impossible t6 evacuate further by road at most times, as traffic jams were extensive~ Even the arrival of the Prime Minister was delayed for an hour because of the traffic. This fully justified the Field Hospital as a holding unit with helicopter evacuation. Though casualties were many more than we had anticipated, treatment provided no difficulties.

Casualty Analysis

Cases treated (See Tables I and H.) The large incidence of headaches was due to hangovers, many cases of low-grade

fever due to malaria and mild dehydration with exhaustion. First-aid personnel gave half a pint of water to drink with each aspirin dispensed; and this probably helped to prevent many cases of severe dehydration. Of the 14 cases of faintness, none was unconscious. All except one, recovered after 15 minutes: rest plus the drinking of water and salt. The one evacuated to the Field Hospital was a woman five months pregnant who recovered by evening. A full casualty analysis, including breakdown into tribes and three-hourly casualty state, is being published in the January edition of the East African Medical Journal. -

Conclusion and Summary

A search of the literature shows that from none of the many recently emergent countries has there been published an account of the medical arrangements of their Independence Festivities. It is hoped that this account will be of value in the future.

A description of the planning and preparation for the medical care and evacuation . of casualties at the Kenya Independence Celebrations, 11th-12th December, 1963, is provided, together with.a statistical analysis of the casualties in a crowd of 250,000 people.

Total Number of patients treated

Needing doctor's opinion Disposal:

TABLE r Summary of patients treated

(a) Treated at First-Aid Posts or by Stretcher-Bearers (b) Evacuated to Field Hospital (c) Evacuated to Maternity Unit (d) Evacuated to Nairobi Hospital

Note (i) This was a case offretal distress evacuated via Maternity Unit to Field Hospital and by helicopter to Pumwani Maternity Hospital, Nairobi.

Number of patients by age-groups Babies (0-1) Children (1~12) Youths (13-20) Adults (21-50) Old People (50 onwards) , ·Pregnant mothers .....

932 (Maximum size of crowd 250,000)

14

911 18 2

I (i)

2 20

137 747

23 3


on Novem



/J R

Arm

y Med C


ownloaded from


44

Headaches Abdominal pains"gastritis, etc. Low-grade pyrexia Lacerations and grazes, Chest infections and coughs Headcold ..... Eye conditions Boils and sores Faintness' Sore throat .... . Toothache .... . Diarrhrea Lacerations needing suturing Backache Mental disturbance Spr~s

NOTES:

Casualty Clearance

TABLE n Analysis of mnes~, ailments, etc.

(In order 0/ /requ(mcy)

654 42 27 (a) 45 31 23 15 (b) 13 12 12 9 5 6 6 4 9

Earache Swollen glands Tooth extraction' Pregnancy Cystitis Burns Dog-bite Human-bite Dislocations ..... Fracture Measles Bee stings Heart failure Pneumonia. Urinary fistula

(e) A transverse fracture oLpatella .. '

3 1 1 3 1 1 1 1 (c) 1 (d) 1 (e) 1 1 (f) 1 1 1

(a) Many eases influenza or malaria. (b) Mainly chronic conjuctivitis. (c) NO.details available.

(f) A severe case which responded to intramuscular piriton.

(d) Sternoclavicular dislocation.

HONORARY CONSULTANTS TO 'THE ARMY

THORACIC SURGERY Professor A. L. d;Abreu, O.B.E., F.R.C.S., has been appointed Honorary Consul

tant in Thoracic Surgery to the Army, in succession to Sir Clement Price Thomas, K.C.V.O., F.R.C.P., F.R.C.S., who has relinquIshed the appointment .

. UROLOGY Howard G. Hanley Esq., M.D., F.R.C.S., has been appointed Honorary Consul

tant in Urology to the Army, in succession to Sir Eric W. Riches, M.C., M.S., F.R.C.S., who has relinquished the appointment.

P A:DIATRICS, . Profess,01: Hock,Boon Wong, M.R.C.S., F:R.C.P., D~C.H., has been appointed

HonoraryConsuItantin Prediatrics to the British Military Hospital, Singapore.


on Novem



/J R

Arm

y Med C


ownloaded from


35 CASUALTY CLEARANCE - BMJ Military Health · combined St. John-Red Cross seminar was held in...

Documents

Transcript of 35 CASUALTY CLEARANCE - BMJ Military Health · combined St. John-Red Cross seminar was held in...