Behind The Scenes Of Batang Kali Landslide Emergency Medical Response

Emergency physician Dr Alzamani details how medical teams from various hospitals, clinics, and the state health department worked together for a coordinated emergency medical response.

KUALA LUMPUR, Dec 26 — Search and rescue (SAR) efforts from the December 16 landslide at the Father’s Organic Farm campsite in Gohtong Jaya, Batang Kali, have been well documented.

After nine days of SAR efforts led by the Fire and Rescue Department, the body of the last victim, an 11-year-old boy, was recovered last Saturday from the disaster that killed 31 people, including 13 children.

While the SAR operation has been well publicised – including the work of tracker dogs from K9 units such as Blake from Bomba, and Leo and Reed from the police force – little is known about what went behind the doors of hospitals’ emergency departments during the landslide disaster.

Dr Alzamani Mohammad Idrose, an emergency physician who was on duty as a consultant at Kuala Lumpur Hospital (HKL) on the night before the landslide, detailed his experience in the early hours of the morning when he was informed of the tragedy.

Based off statements from his Facebook post and written statements he gave in response to questions from CodeBlue, it was two in the morning of December 16 when the hospital appeared to have sunk into a calm lull for Dr Alzamani, who had his hands full with an an accident case and a Covid patient who had water in their lungs.

Little did he know that a mere 43 minutes later, Selayang Hospital would receive a devastating 999 call.

Dr Khairul Izwan, an emergency specialist on duty in HKL that night, informed Dr Alzamani of the landslide. According to a copy of the early information that the hospital had received from the 999 system, there were 1,000 victims caught in a landslide at Batang Kali, Selangor. (The eventual number of people affected by the disaster later turned out to be 92, including 61 survivors).

HKL staff called Selayang Hospital at 4.05am for an update and wanted to know whether Selayang Hospital was in need of assistance. They were told that a team from Kuala Kubu Baru Hospital had arrived at the disaster zone, but there was a problem with accessing the site.

At 5.01am, the specialist from Selayang Hospital called HKL, and this time, it was a request that the hospital be on standby.

Immediately, the team on duty activated the Disaster Plan, setting HKL on Yellow Alert, which placed the hospital on “standby” – informing staff that the hospital was at risk of receiving a large number of patients due to a massive disaster.

The plan also told hospital staff to “create extended or new areas to treat the disaster victims, including areas for families to find information and also get our psychologists and psychiatrists involved as well for psychological first aid”.

If this risk does become a reality and the hospital does receive patients, then the Red Alert will be activated. In such a situation, the entire hospital will send officers to aid the many patients that pass through the hospital doors.

“It’s fine. We will activate ‘Yellow Alert’. Inform the supervisor and open the zone. Call Datuk Mahathar and inform him. Insert information in our group,” wrote Dr Alzamani in his Facebook post.

According to Dr Alzamani, as Selayang Hospital and Kuala Kubu Baru Hospital were closest to the disaster zone, their teams were sent to the location. And Tunku Azizah Hospital, a children’s hospital, was also put on Yellow Alert as they had been informed that more than 20 children were caught in the incident.

Tunku Azizah Hospital, which was next to HKL, emptied their resuscitation area as they were “extremely worried” that there would be many badly injured children.

“In a response like this, the hospital closest to the location of the incident will play the role of the Primary Response Hospital (coordinating responses), whereas the other hospitals become Secondary Response Hospitals (aiding hospitals),” wrote Dr Alzamani.

The group that Dr Alzamani had updated was the middle-level managers workgroup that comprised the head of department, supervisors, head nurses, specialists and senior medical officers.

In addition to the hospital’s workgroup, Dr Alzamani created another WhatsApp group that comprised key players from HKL and Selayang Hospital so they might coordinate their response to the emergency.

“From here, we decided that patients would be distributed amongst a few hospitals. All head injury patients will be sent to HKL as we have a neurosurgeon, while patients with minor injuries will be discharged from the site.

“All dead will be sent to only one centre – initially the forensic specialist advised to be sent to HKL, but the police decided for all to be sent to Hospital Sungai Buloh. The head of the national forensic institute was alerted as well,” wrote Dr Alzamani.

Shortly after HKL was placed on Yellow Alert, Dr Alzamani heard his mobile phone ring. The call was from Dr Edelina, an emergency and trauma specialist from Selayang Hospital, informing him that the Selayang team led by Dr Thayaharan Subramaniam, an emergency specialist, was at the disaster zone.

“Hello Doctor, I’m Dr Edel, a specialist at the Selayang Hospital. The Selayang team is at the location of the landslide. So far, we have 38 ‘green’ victims. There are five children and 23 more (victims) have yet to be found. The firefighter team is trying to go in because access is hard,” she said.

“Okay, Edel. it’s fine, we standby to receive patients here. Later we will send an ambulance team to help. We plan for all patients who have brain injury to be brought to HKL. Green Patients, if they don’t need an X-ray, can settle on location. Red Patients and Yellow can be distributed between Selayang Hospital, Kuala Kubu Baru Hospital, HKL, and Sungai Buloh Hospital,” replied Dr Alzamani.

According to Dr Alzamani, emergency patients are categorised as red, yellow, or green. These traffic light colours represent the “colours of life” when it comes to the stability of the patient: red (critical), yellow (semi-critical), and green (non-critical).

By the time Dr Edelina called Dr Alzamani, the fire and rescue and medical teams from Selayang Hospital, Kuala Kubu Baru Hospital, and clinics nearby were at the disaster zone.

Based on the information given by Dr Alzamani, hospitals normally send out one team to the disaster zone, and only if more are needed will the hospital deploy more teams. When it comes to public health clinics, they have “rapid response teams” that are deployed to the site via the district medical officer.

These teams would be led by an emergency specialist who acts as the On-Scene Medical Commander (OSMC). According to Dr Alzamani, “Their job is to assess the situation and report for assistance, set up a Medical Base Station, triage patients, i.e., determine severity of illness and discharge or send patients to hospitals. All medical teams will be managed by OSMC”.

That night, Selayang Hospital’s Dr Thayaharan was in charge of the response on the field. He even had the help of the district public health specialist who had sent a team to provide aid and set up the Operations Room (Bilik Gerakan).

Back at HKL, Dr Alzamani’s supervisor was ordered to open treatment zones and the Emergency Zone Command Centre, so as to be ready to receive patients. Even the Operations Room’s doors were open, though it would not start operations until a Red Alert was declared.

In addition to the opening of zones, all the patients who were currently in these zones that needed to be admitted into wards were quickly admitted, and Dr Alzamani briefed all zones so that staff were ready.

Despite the occurrence of a disaster, Dr Alzamani stated that hospitals do not automatically prioritise disaster zone patients, but rather, the triage process determines which patient will be seen first. This is always based on how critical the patient is — regardless of whether or not they are a disaster victim.

“No matter what, critical patients will be seen first.”

Thus, in this manner, treatment for both disaster victims and the hospital’s current emergency patients will run parallel to each other, “with more staff alerted from other departments or home deployed to the extended areas we create.”

By the end of his shift, HKL was ready to tackle all possibilities. Dr Alzamani surrendered his shift to Dr Cyrus. All the specialists in the emergency department were informed of the situation. They were ready to give whatever treatment that was necessary.

When handing over shifts in situations like this, staff on the next shift are able to obtain information they need from the Emergency Zone Command Centre that has a “big white board and information”, according Dr Alzamani.

For on-site rotations, the Medical Base Station will help the next team keep up with the evolving situation.

“There are no problems for the next doctor to take over as they are usually emergency medicine specialists (called emergency physicians) and we are all trained in disaster management,” wrote Dr Alzamani.

“I believe that the same thing is happening in Selayang Hospital, Kuala Kubu Baru Hospital, and Sungai Buloh Hospital. Our team contacted the Selayang Hospital team in particular, and we work together to deal with this crisis. We contacted the head of department of the aforementioned hospital, Datuk Dr Alwi and specialist Dr Khatijah, and shared information.

“All this is necessary because the hospital is the receiver of the disaster ‘product’. This is the destination of patients, especially the terminally ill.”

HKL was the recipient of a single patient from the landslide disaster, who was triaged, immediately managed, sent for a CT scan, and admitted. A total of 53 patients were discharged from the landslide site.

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