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Emergency Medical Services During the Siege of Sarajevo, Bosnia and Herzegovina: A Preliminary Report

Published online by Cambridge University Press:  28 June 2012

Ernesto A. Pretto ,
Mirsada Begovic  and
Mirza Begovic
Ernesto A. Pretto*
Affiliation:
Director, Disaster Reanimatology Study Group, International Resuscitation Research Center, Department of Anesthesiology/CCM, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Mirsada Begovic
Affiliation:
Clinical Center of theUniversity of Sarajevo, Bosnia and Herzegovina
Mirza Begovic
Affiliation:
State Hospital of Sarajevo, Bosnia and Herzegovina
*
Disaster Reanimatology Study Group, International Resuscitation Research Center, Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260USA
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Abstract

Background:

The siege of Sarajevo is a longterm, human-made, medical disaster of international significance. The delivery of emergency health care provided to the large civilian population held captive in that war zone for an extended time was studied.

Methods:

In May 1993, a humanitarian and fact-finding visit to Sarajevo was conducted. Physicians, administrators, and public health officials were interviewed; epidemiological data were acquired—the resuscitation of war casualties at the two largest hospitals were observed; and local published reports and videotaped footage on the organization and delivery of prehospital and hospital care were reviewed. The videotapes also served to document war crimes.

Results:

Daily bombardment and sniper fire directed at civilians have caused a steady stream of casualties (64,130, or an average of 119 killed or injured per day in 18 months). Eighty percent of the victims were civilian. Despite hazardous conditions from direct shelling, disruption of vital lifelines, and shortage of supplies, medicines, oxygen, and anesthetics, the physicians continue to provide at least a minimum standard of resuscitative care. Seventy percent of all war victims were transported to hospitals in private vehicles. Most casualties (93%) received some form of prehospital, basic first-aid from lay bystanders or first responders. From November 1992 to February 1993, 27,733 patients were treated in hospitals, resulting in 2,139 major surgical procedures. The primary cause of death in 71 of 273 victims was prolonged hemorrhagic, hypovolemic shock. Sixty-one percent of these victims died within 24 hours of injury.

Conclusions:

Continuous needs assessment be accompanied by rapid delivery of outside aid. International “peacekeeping” forces should protect hospitals and their staffs, and ensure the entry of supplies and evacuation of some patients. A public trained in life-supporting first-aid, and physicians and paramedics with experience in advanced life support may have enhanced lifesaving efforts in Sarajevo.

Keywords

disaster epidemiologydisaster medicinedisaster responseemergency medical serviceshospital damagemilitary medicineneeds assessmentparamedicphysicianspublic healthshocksupplies, shortag oftrauma surgeryvictimswarwar crimeswar injuries
Type
Invited Papers
Information
Prehospital and Disaster Medicine , Volume 9 , supplement S1: Invited Papers from Sarajevo , June 1994 , pp. S39 - S45
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1994

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References

1. Pretto, E, Ricci, E, Safar, P et al. : Disaster reanimatology potentials: A structured interview study in Armenia III. Final results, conclusions and recommendations. Prehospital and Disaster Medicine 1992;7:327–338.Google Scholar
2. Klain, M, Ricci, E, Safar, P et al. : Disaster reanimatology potentials: A structured interview study in Armenia I. Methodology and preliminary results. Prehospital and Disaster Medicine 1989;4:135–152.Google Scholar
3. Ricci, E, Pretto, E, Safar, P et al. : Disaster reanimatology potentials: A structured interview study in Armenia II. Method for the evaluation of medical response to major disasters. Prehospital and Disaste Medicine 1991;6:159–166.Google Scholar
4. Pretto, E, Angus, D, Abrams, J et al. : Prehospital deaths in an earthquake. Prehospital and Disaster Medicine 1994;9:107–117.Google Scholar
5. Bissell, R, Pretto, E, Angus, D et al. : Post-preparedness response in Costa Rica. Prehospital and Disaster Medicine 1994;9:96–106.CrossRefGoogle ScholarPubMed
6. Ceciliano, N, Pretto, E, Watoh, Y et al. : The earthquake in Turkey in 1992: A mortality study. Prehospital and Disaster Medicine 1993;8:s139 Abstract.CrossRefGoogle Scholar
7. Pretto, E, Angus, D, Abrams, J et al. : Prehospital deaths in three earthquakes. (Abstract) Prehospital and Disaster Medicine 1993;8:s141Google Scholar
8. Ricci, E, Pretto, E: Assessment of prehospital and hospital response in disaster. Crit Care Clin 1991:7:471–484.CrossRefGoogle ScholarPubMed
9. Smajkic, A: Health Consequences of the Aggression in Bosnia and Herzegovina. Unketen 97. 21 February 1994.Google Scholar
10. Begovic, M, Mazlagic, D, Strauss, S, Mazlagic, B: Blood transfusion requirements among war casualties in Sarajevo. Prehospital and Disasater Medicine 1994;9:s20–s24.CrossRefGoogle ScholarPubMed
11. Vujovic, B, Nakas, A, Mazlagic, D, Covic, R: Epidemiology and surgical management of abdominal war injuries in Sarajevo: State hospital of Sarajevo experience. Prehospital and Disaster Medicine 1994;9:s29–s34.Google Scholar
12. Vujovic, B, Mazlagic, D: Management of abdominal war injuries at the Surgical Department of the State Hospital of Sarajevo. Bulletin (Bitten) of the State Hospital of Sarajevo 1993;2:s13–s16Google Scholar
13. Toole, MJ, Galson, S, Brady, W: Are war and public health compatible? Lancet 1993;341:1193–96.CrossRefGoogle ScholarPubMed
14. Acheson, D: Health, humanitarian relief, and survival in former Yugoslavia. Br Med J 1993;307:44–48.CrossRefGoogle ScholarPubMed
15. Kuzman, M, Tomic, B, Stevanovic, R et al. : Fatalities in the war in Croatia, 1991 and 1992. JAMA 1993;270:626–628.Google Scholar
16. Geiger, JH, Cook-Degan, RM: The role of physicians in conflicts and humanitarian crises. Case studies from the field missions of physicians for human rights, 1988 to 1993. JAMA 1993;270:616–620.CrossRefGoogle ScholarPubMed
17. Safar, P, Pretto, E, Bircher, N: Disaster resuscitology including the management of severe trauma. In: Baskett, P, Weller, R (eds): Medicine for Disasters. London: Wright-Butterworth 1988:36–86.Google Scholar
18. American College of Surgeons Committee on Trauma: Collicott, PR, ed. Advanced Trauma Life Support for Physicians. Chicago: American College of Surgeons, 1984.Google Scholar
19. Cowley, RA, Dunham, CM: Shock Trauma/Critical Care Manual. Initial Assessment and Management. Baltimore: University Park Press; 1982.Google Scholar
20. Dow, AC, Baskett, PJF: Anesthesia and analgesia in the field. In: Grande, C et al. (eds): Textbook of Trauma Anesthesia and Critical Care, St. Louis: Mosby; 1993:297–308.Google Scholar
21. Arishita, GI, Vayer, JS, Bellamy, RF: Cervical spine immobilization of penetrating neck wounds in a hostile environment. J Trauma 1989;29:332–337.Google Scholar
22. Safar, P, Bircher, N: Cardiopulmonary-Cerebral Resuscitation: An Introduction to Resuscitation Medicine. London: UB Saunders. 1988.Google Scholar