They presented in surges however and the highest surges were on days 2 and 3 with fewer patients seen on days 1 and 4. Some patients were attended to without being registered. selleck inhibitor Of those that were registered, the records of 74 were not available, leaving that of only 389 for analysis. There were 348 (89.5%) males and the median age was 26 years. Table 1 shows the mechanisms

of injury with the most common being gunshot in 203 patients (52.2%) and cuts from machetes and knives in 161 patients (41.4%). Table 2 shows the distribution of the injuries by body part, the most frequently affected being the head and neck in 171 patients (44.0%) and the extremities 168 patients (43.2%). Some patients had injury by multiple mechanisms and sustained injuries to multiple body parts. Table 1 Mechanisms of injury Mechanism   No % Penetrating         Gunshot 203 52.2   Machete/knife cuts 161 41.4   Arrow impalements 14 3.6

Blunt         Clubs/sticks 44 11.3 Burns         Flame 7 1.8 Total   429 100* *: Some patients had injury by multiple mechanisms. Table 2 Body parts injured Body part No % Head/neck 171 44.0 Extremity 168 43.2 Abdomen/pelvis 65 16.7 Chest 30 7.7 Total 434 100* *: Some patients had injury to multiple body parts. Table 3 summarizes the challenges encountered in the response to the crisis. www.selleckchem.com/Akt.html Communication was a major challenge, both within and outside the hospital and for collaboration with other agencies responding to the crisis. LY3039478 mouse Field challenges

included the violence on the streets, the lack of field triage and the absence of pre-hospital care. Within the hospital, supplies of consumables were quickly exhausted, record keeping was poor, and exhausted staff began to show signs of strain. Hospital safety became threatened at a point both from rising tensions within the premises and from threat of attack from outside. Some patients suffered suboptimal care for reasons ranging from exhaustion Amobarbital of hospital supplies to being forgotten in the heat of the crisis response. Table 3 Challenges encountered Communication       Internal     External     With other agencies   Field challenges       No triage     No pre-hospital care     Hazard to medical personnel   Hospital challenges       Exhaustion of supplies       Intravenous fluids     Drugs     Sterile dressings     Sterile instruments     Blood   Poor record keeping       Non registration     Non documentation     Incomplete documentation   Staff exhaustion       From fatigue/overwork     Anxiety/tension   Hospital safety       Rising tensions within     Threat of attack from outside   Suboptimal patient care       From exhaustion of supplies     Forgotten patients     Non trauma patients     Patients on admission prior to onset of crisis Discussion The lack of communication between our hospital and the field meant that we were totally caught unawares at the onset of the crisis.