The document summarizes the challenges faced by the anaesthesia and critical care department of Kathmandu Medical College during the 2015 Nepal earthquake. It describes how the department had to deal with many trauma cases, pregnancies, and other emergencies. All staff worked together to tackle issues during this difficult period. It notes problems faced like lack of disaster supplies and discusses temporary operating theaters set up in containers and tents. It concludes with recommendations for being better prepared for future disasters.

1. Disaster and anaesthesia debriefing:
Earthquake 2015,
Kathmandu Medical College ,
Sinamangal, Nepal
Department of Anaesthesiology and critical care , KMCTH
27 th may, 2015
Dr Bisharad Man Shrestha ,Professor, Head of Department
Dr Shyam Krishna Maharjan, Professor
Presented by :Dr Santosh Dhakal, 3rd yr Resident, KMCTH

2. • One of the deadliest natural calamities was
faced in Nepal leading to many casualties,
handicapped people, homeless and
psychological illnesses.
• People came forward to help the victims and
victimized family !
• Meanwhile , we all stood still and tried our
best to face the challenges at this time of
disaster .

3. • Anaesthesia and critical care department had
to deal with many challenges regarding the
proper care of the victims who came with
trauma; pregnancy cases and other
emergency situations.
• Also we provided the regular care of the
patients who were admitted in various ICUs (
ICU, Neuro ICU, MICU ) , postoperative ward
and emergency.

4. • All the anaesthesia team, the surgical team,
nursing team and other staffs worked hand in
hand with coordination with the
administration to tackle various issues and
problems during this period.
• “TOGETHER WE CAN MAKE A DIFFERENCE”
• “SALUTE TO ALL”

5. Disaster Audit, 2072

6. Audit contd…

7. Audit : Disaster
• Total cases : 382
• Spinal anaesthesia : 252
• General anaesthesia : 86
• Intravenous anaesthesia : 30
• GA with nerve blocks : 3
• Epidural : 11

8. Blocks : 52
• Interscalene : USG : 1 , USG + PNS : 5
• Supraclavicular : landmark : 7,USG : 1, USG + PNS
: 5
• Axillary : Landmark : 7 , USG : 1, USG + PNS : 7
• Popliteal : 4
• Saphenous : 2
• Femoral : 8
• Sciatic : 2
• Wrist : 2

9. Other procedures :
• Epidural Steroid injection : 1
• Central venous catheterisation : IJV : 5,
Subclavian : 5
• Haemodialysis catheter : IJV : 2, Subclavian : 1
• Monitored anaesthetic care : 3

10. • INITIAL STAGES AFTER 1ST EARTHQUAKE , april
25 , 2015 .
• Biggest challenges : Early resuscitation and
critical care
• Patient care during period of triage with
maximum involvement of the staffs and
volunteers.
• coping up with the aftershocks

11. Problems :
• Panic and injury while in OT with falling objects :
oxygen cylinders, trolleys, anaesthesia machine.
• No proper responsible immediate disaster
response team to contact for decision
• Transfer of patient from ICU/Postoperative ward,
patients in OT.
• No emergency easy exit from 6th floor.
• No immediate space for ER/OT/Postop/ICU
patients
• No backup light in OT during surgery

12. Problems : contd..
• Inadequate disaster store materials : iv drips,
airway equipments, monitors, anaesthesia
equipments.
• 24 hour duty doctors/nurses/paramedics :
lodging, fooding, communication.
• Inadequate management effect to decrease
anxiety level for early stabilisation
• Emergency management of disaster not well
carried out : crowd control, triage ?,
resuscitation.

13. Container :

14. Container and issues :
• Earliest possible need for emergency surgery
• Mobilisation and utilization of manpower for
making a disaster OT setup.
• Ambulance service for transfer of cases.
• Problems : tipping table, ventilation, scrub
facilities, temperature and humidity .

15. Portable ventilator at container :

16. Monitoring at container :

17. Light Source :

18. OT Light and oxygen setup :

21. Indian Army Camp :

22. Army Camp and issues :
• Good co-operation by indian medical team
and nepalese armed police force.
• Better part : proper anaesthesia machine
setup, proper scrub facilities.
• Issues : temperature and humidity,
scavenging, mosquitoes.

25. Working together :

26. Regional anaesthesia :

29. Ether vaporizer at Indian army camp :
• Historical importance

30. Working at tent in parking area :

31. Tent and issues :
• Good initiative by armed forces and our kmcth
team.
• Had better spacious space and proper
anaesthesia workstation.
• Issues : temperature and humidity, scrub with
just spirit and betadine, slippery.

32. Working at different floors of hospital :

33. KMCTH Ots and Issues :
• Good co-operation between faculties and
other staffs.
• Huge platform for anaesthetic management
for disaster and other surgeries.
• Working hand in hand with regular
communication and handovers.
• Issues : major technical problems, lack of
blood arrangement, overwhelming upper floor
fears and panic situations.

34. OT at various floors : scary stories

35. Earthquake in between :
Caesarean section while
during 2rd major
aftershock

36. Other concerns :
Proper Duty room and sleeping facilities.
Requirement of simulation exercise/drill.
Appropriate responsibility allocation during
transfer of patients and instruments.

37. United we stand!

38. Some of the Volunteers for disaster ot
management:

39. Volunteering in anaesthesia !

40. What to do next : Recommendations
• Stay calm and make calm.
• Help physically, mentally and socially
eapecially for those who are tired and worn
off during this period.
• Replace, fulfill and purchase drugs,
instruments and equipments.
• Normalize the daily working condition with
due respect view of all the working staffs
• Be ready, be prepared.

41. Recommendations : contd
• Adequate light, extra portable oxygen supply,
portable ventilators, extra UPS, batteries or solar
panels .
• Easy early disaster response team for decision.
• Work division : adequate trolley, transport,
professional approach of patients from ICU, OT,
POW.
• Emergency exits on various floors.
• Allocation of emergency OT space for disaster/
ICU/ POW.

42. Recommendations : contd..
• Materials adequate : iv fluids, airway
management equipments, anaesthetic drugs,
portable machines.
• International standard OT/POW/ICU in first
floor building ; benefits : transfer, emergency
exit will be easy, cost effective ( less use of lifts
and manpower ) , less anxiety in manpower.

43. How to get ready for future :
• Earthquake simulation programmes.
• Special training in disaster management.
• Arrangement of immediate backup OT setup
for any sorts of natural calamities.
• Difficult intubation trolley cart along with
recent airway devices including fibreoptic
bronchoscope and subcutaneous
tracheostomy sets.
• Long term plans

44. STILL MUCH MORE TO DO !!!
• Thank-you ! Pray and work for Nepal !!!
• SALUTE TO ALL OF YOU
• Thanks for bearing with me .

45. Silver lining above KMCTH !!! LET’S
UNITE FOR OUR KMC

46. “United we stand , divided we fall”