Orthopaedic terror medicine: an assessment of a cohort of Johannesburg Orthopaedic surgeons' response to a questionnaire on their hospital's preparedness for injuries associated with an explosive type terrorist attack

Abstract

Background: International terrorism has claimed an average of 21 000 deaths per year over the past decade with the highest total being in 2015 with 35 320 injuries and resulted in 28 328 deaths. The medical management of terrorist victims has given birth to a new branch of Emergency and Disaster Medicine called Terror Medicine. Multi-modal types of terrorism creates significant orthopaedic injuries amongst survivors through a combination of blast, penetrating and blunt force mechanisms. The aim of this research was to assess the current perception of preparation amongst orthopaedic surgeons in a selection of Johannesburg public and private hospitals to an explosion type terrorist attack. Methods: Ethical approval was granted to distribute the author’s questionnaire which covered a wide range of topics related to multidimensional trauma and the possible requirements of the healthcare providing facility. The questionnaire was distributed to 101 orthopaedic surgeons working at both public and private hospitals in the greater Johannesburg area. Descriptive analysis of all question responses was undertaken and the responses between public and private hospitals were compared. Results: Of the 39 orthopaedic surgeons who participated in the study, 22 completed the questionnaire from the private sector and 17 from the public sector. There was a significant, strong association with the hospital sector (p=0.0049; Cramer’s V=0.52): 53% of respondents from state hospitals reported preparedness, compared to only 9% from private hospitals. There was a significant, moderate association with the hospital sector (p=0.031; Cramer’s V=0.42): n=10 of 17 (59%) of state respondents reported having a standby protocol (whereby additional orthopaedic surgeons can be activated on site in the event of an mass casualty incident), compared to only n=4 of 22 (18%) from private hospitals. Conclusion: The study results suggest that public hospitals appear to have access to higher numbers of staff and theoretically, more readily available equipment compared to private hospitals. In the event of a terrorist mass casualty incident, there will be a need for a well-established public/private hospital partnership. A national assessment of hospital preparedness is recommended. As well, the development of a Terror-Medicine course that is offered at a post-graduate level is encouraged