Afghan Avalanche

We have been preparing for several weeks mentally for a huge influx of patients. The well publicized offensive on the horizon along with the "Afghan Surge" will likely bring many more casualties our way. But, much to everyone's surprise our first mass casualty event had nothing to do with war.

We had a small snow storm in northeastern Afghanistan over the weekend. The mountains surrounding us are now covered in snow. Apparently there is a mountain pass that is highly traversed between Kabul and Mazar-e-Sharif up north. 2 days ago an avalanche occured onto this mountain pass. It was approximately 2 miles wide apparently. Hundreds of Afghans were trapped. The temperatures were in the teens and twenties.

A "mascal" was called yesterday afternoon. The entire hospital staff was ready. We waited for several hours with all of our equipment at the ready. We had about 20 doctors including myself in the trauma bay prepared for the worst. Thankfully, it was not so bad. Most of the people were walking wounded, or not really even patients at all. Many were basically refugees. They had nowhere else to go, so coming to an American base was their best option. As with any calamity, there were a lot of rumors flying and a ton of misinformation. Several hours after the entire staff was called in, patients started coming my way to be admitted to the ward.

Frostbite was the number one diagnosis. We admitted a slew of patients with hand and foot frostbite mostly to monitor them. Their extremities needed to be re-warmed and time given for the tissue to be re-perfused. One patient of mine arrived with a body temperature of 84! He received warm IV fluids at 104 degrees. He had special blankets put on and a continuous temperature probe inserted. Amazingly, he was alert and talking a little bit even when he was severely hypothermic. It took 2-3 hours for his temperature to return to normal. His feet were swollen and blue. By morning the color in his feet was returning. He was moving his toes. Most of his feet had sensation. Our orthopedic surgeon held off on amputation. It would take weeks for the extent of the injury to declare itself.

When all was said and done, we had a ward full of patients and a tent full of refugees. One patient did die here. Heroic measures were taken, but he was too far gone. Most of our Afghan patients were seen, treated, and transported off the base within 24 hours. We have to be ready for the next wave of patients, so there is not time to delay. Sadly, I was told by someone that hundreds of people were left at the avalanche site. Our choppers could only transport a fraction of the victims. The news today is reporting 150 dead in the avalanche. It's a stark reminder that we are in a third world country and that mother nature is so very powerful.