150 years of healing:

Handling trauma and mending broken bones

Reviewed by Carol Aloysius

Accident Services Director Dr Kapila Wickremanayake gives us a glimpse into the past history of one of the most important and vital medical units in the country’s premier national state, the National Hospital of Sri Lanka (NHSL) in his article titled ‘Accident and Orthopoedic Service.’ It was published in Legacy of 150 years published by the NHSL and compiled by the hospital’s Coordinating officer, NHSL, Dr Ramya L. Premaratne.

Date: January 31.
Time: 10.45 a.m

It began like any other normal day with most people in the Fort and Pettah busy shopping, or taking a short break from their office work. For the Central Bank employees mid morning was usually the time when most of their customers began rushing in to get help for their numerous financial transactions.

At 10.45 a.m. the lives of most of them changed dramatically - and violently, when a container carrying around 440 pounds of explosives belonging to the most deadly militant group in the country, crashed through the main gate of the island’s premier financial hub, leaving an eight foot crater in front and causing the bank to collapse.

The results were devastating and horrific. Nearby streets up to a mile and a half away from the bloody scene were strewed with shards of glass, metal pieces and bodies of victims. A few who managed to escape with wounds stumbled their way to the nearest hospital, the General Hospital where a crew of doctors, nurses and paramedics already informed of the incident, stood waiting to whisk them away to be treated in outdoor patients units, or in the Intensive Care Units. It was the calm and efficient manner in which this medical team coordinated and carried out its work while trying to soothe and allay the fears and panic of relatives, that helped save so many who would otherwise have succumbed to their injures that day.

Recalling the event still etched in the minds of all who witnessed it, Accident Services and Orthopoedic Services (AOS) Director Dr Kapila Wickremanayake says in his article, ‘The Accident Service has experienced many mass casualty incidents especially since the time the North East conflict erupted. The worst disaster this Service managed was the bomb blast at the Fort near the Central Bank on January 21, 1996 which killed 60 persons and injured 1,350 innocent people”.

As a means of reference to those interested, he includes a summary of major incidents, disasters, assassinations handled by the AOS, giving exact details of time, place and the kind of accident plus the numbers injured and dead. The figures of those injured and treated by the Accident Service in bomb blasts alone is mind blowing. Running into thousands from the time of the first bomb blast in Colombo at the Central bus stand in Pettah in 1996, upto the final bomb explosion in front of the air Force Camp in 2009, the list reveals that the number of fatalities were comparatively low, a testimony to the quick service given to persons injured by them with the sole intention of saving their lives and preventing further complications.

Commenting on the present AOS which has come a long way since its inception way back in the 1960s, Dr Wickremanayake says, “Today, the Accident and Orthopoedic Services of the NHSL is the premier designated trauma care center in Sri Lanka. It treats around 100,000 patients per year of which one third are given in house care.” He points out that , “In Sri Lanka, trauma injuries are one of the leading causes of hospitalization accounting for 16 percent of admissions to government hospitals in 2012. The Accident and Orthopedic Service being the largest and best equipped trauma care center , caters to those who are injured in accidents”.

History

The present eight storeyed AOS building was built and equipped under the General Hospital’s Rehabilitation Project funded by the Finland Government and declared open by former President R. Premadasa in 1991. Consisting of three operating theatres, two ICUs, two Observation wards, a Blood bank and Radiological facilities including X-ray units IT and MRI which function 24 hours a day, the hospital has a Casualty team, including a Casualty surgeon physically present on the premises at all times. The Orthopoedic Dept. to rehabilitate patients and give them mobility after a serious accident, has four units with 430 beds under the supervision of four senior orthopedic consultants.

In 2011, the Accident Service received a further boost when it was expanded with the opening of the Neuero-Trauma Center funded by the Kingdom of Saudi Arabia.

The Centre now boasts of a Neuro-trauma Centre with Emergency treatment unit, 8 operating theatres, six ICU units, four High Dependency Units, and a ward with 228 beds to provide a better service to patients with head injuries.

Helipad

One of the most innovative modern introductions to help the Accident Service to be abreast of international hospitals, is the Helipad built to facilitate transfer of critical patients by helicopters in an emergency situation, Dr Wickremanayake says.

Housed in the old Victoria Memorial Eye Hospital, the present day complex was later moved to a plot of land adjacent to it in 1965. Two years later on New Year’s Day the newly constituted Accident Ward was inaugurated by former Prime Minister Dudley Senanayake.

Bomb blasts

In a separate section C titled ‘Challenges to Accident Service the Doctor recalls major incidents requiring services of the Accident Services at the General Hospital due what he says, “was the continuation of the North separatists movement (LTTE) and Southern insurgency (JVP)”.

The details given are both informative and thought provoking.

We reproduce some of the highlights”.

*A.

Pettah bomb blast, at the central bus stand - 21st April 1987 at about 5.00 p.m. by the LTTE 106 killed, 295 injured treated at the old accident service.

The male ward 52, had only 60 beds and female ward 53 had only 18 beds. The 295 injured, laid two in a bed, on the floor of the wards and trolleys and veranda some just on the floor. Meanwhile,160 beds obtained from the adjoining Ragama section medical wards, by Requisitioning 20 beds each from wards 41 to 46 and wards 47 and 49. Moderately severe and non-seriously injured transferred to the 160 beds in medical wards. These Medical wards put in charge of 3 surgical consultants. Balance patients in wards 52 operated where necessary in general surgical theatres and later transferred to surgical wards. The dead filled the mortuary of Accident Services and the rest in General Hospital mortuaries, balance bodies accommodated temporarily in large open garage near ward 52. The identified list of the dead was put up outside by 3.00 a.m. for information of people anxiously waiting for news of the missing dear ones.

*B.

LTTE Maradana Bomb Blast - 11th September 1987, 23 dead brought to old accident service and identified from NIC and passport etc. Transferred to Police Mortuary, 106 injured treated in ward 52 of old accident service and in general surgical theatres and transferred to general surgical wards.

*C.

Assassination of Deputy Defence Minister Ranjan Wijeratne - March 2nd 1991 some injured in the assassination of Deputy Minister of Defence, Mr. Ranjan Wijeratne, at Havelock Town by LTTE bomb blast. Injured treated at the accident service. The Hon. Ranjan Wijeratne’s body taken directly to JMO Department and police Mortuary.

*D.

J.O.C. Bomb Blast at Flower Road - 21st June 1991, dead and most injured taken directly to army headquarters, Slave Island. Some injured treated at General Hospital, Colombo Accident Service.

Casualties treated at the new accident service.

* Assassination of Lalith Athulathmudali - 23rd April 1993 at Kirulapone, shot while at a rally by 2 bullets from a pistol. Body in Accident Service ICU and kept for 8 hours due to severe agitation and tension in front compound of the hospital by his supporters. Body quietly removed in an ambulance, from the near accident service exit. News of his death was released to the public only then and the body was transferred to Police Mortuary, and the crowd dispersed.

*Assassination of President Premadasa - 1st May 1993 at Armour Street Junction at May Day rally along with 23 others. Mangled body brought in a lorry along with other bodies to the accident service. Later transferred to Police Mortuary/JMO services after required official formalities regarding HE’s death.

*Assassination of Gamini Dissanayake - 24th October 1994, and 54 others killed by female suicide bomber, bodies brought to the accident service. Among the dead were Mr. Mallimarachchi and Hon. E.H. Premachandra, Dr. Gamini Wijesekara and others. Mr. Ossie Abeysekara however was severely injured and treated in the accident services intensive care for several days, but died later.

SECTION – D

Southern insurgency - Report on Occurrences by JVP

1.Southern insurgency responsible for several deaths by shooting inside General Hospital after visiting hours in the surgical wards.

2.Interruption to traffic and bus services and causing civil commotion, necessitating the hire of 5 buses from Messrs. Ebert Silva, for transport of health staff from the homes to Hospital and back.

3.Grenade attack in Parliament - On August 18th 1987, a grenade attack was launched by a JVP parliamentary employee on the conference room of parliament at a meeting held by UNP Ministers and MPs Presided over by J.R. Jayewardene and attended by Prime Minister R. Premadasa. The injured Messrs R. Premadasa, Gamini Jayasuriya, Monty Jayawickrama, E.L.B. Hurulle along with 8 other ministers were treated in the Merchants ward and class 1 of the paying ward.