Christchurch mosque shootings an unprecedented disaster, emergency doctors to tell symposium

An armed police officer standing guard at the entrance to Christchurch Hospital on the day of the mosque shootings. Photo / Mark Mitchell

Minutes after the shooting began at Al Noor Mosque, two men who had escaped the attack sprinted into Christchurch Hospital's emergency department.

They were bleeding from cuts suffered smashing a window in the masjid to get away from the gunman, and it was the first inkling doctors had that something unprecedented was happening outside.

The emergency medicine specialist who led the department's trauma response on March 15, Dr Dominic Fleischer, will tell his peers at a symposium for emergency doctors next week how a Major Incident Plan [MIP] and a massive team effort kept all but one of the victims who arrived in the ED that day alive.

No sooner had the first two patients arrived shortly after the 1.40pm shooting began but the 45 patients already in the ED were moved to wards in preparation for mass casualties.

"And then you had a huge influx of doctors and nurses from within the hospital who came down to help," Fleischer said.

Dr Dominic Fleischer, emergency medicine specialist at Christchurch Hospital led the emergency department's trauma response to the Christchurch shootings. Photo / Supplied

There were extra nurses on site because of a shift change and extra surgeons and anaesthetists because it was a departmental teaching day.

Ten minutes after the shooting began, the first critically injured patient arrived "and everything changed very quickly".

"Disbelief was my first impression. I never imagined the sheer number of patients that were about to arrive."

Before the last bullet was fired at Linwood Mosque about 15 minutes later, the MIP had been activated.

At the same time, Armed Offenders Squad police poured into the ED looking for a gunman, posting officers around the hospital.

"Every shift you see police coming through the department but what you don't see is police in full SWAT gear with semi-automatic rifles running through the department. That's exceptional."

Under the MIP, patients were given a pre-printed disaster number for identification which tracks them through the hospital.

"Because how do you keep track of 50 patients who arrive at once? They're all overwhelmingly male, of a similar age, few spoke English, they had very similar injuries and that was really tricky to make sure you didn't confuse them."

One unmistakable patient was then 4-year-old Alen Alsati who had been shot multiple times alongside her father Wasseim Alsati.

Fleischer said Alen was only in the ED for 14 minutes before being rushed away for surgery.

"That's a phenomenal time limit for a trauma. She was just pounced on by doctors and nurses as soon as she arrived.

"Every single patient in this case needed multiple operations. On that day, in the first hour, every single one needed theatre. It was a surgical emergency."

Many of the large teams treating each patient included specialists who were strangers to each other because of the different departments all pulling together.

Behind the scenes, "a whole army of social workers" converged on the ED to help the families of victims find their loved ones.

"For the one person who came in and died in the ED, his wife was brought to his bedside within minutes of his arrival which is phenomenal work by the social workers."

Fleischer said he would tell the Australasian College for Emergency Medicine symposium, which opens on Tuesday in Rotorua, how to work in an "immensely chaotic event when it comes out of nowhere and hits you".

He was proud of the hospital's care that day but said he expected the traumatic effects would be felt by staff in the months and years to come.

"We're used to being involved in stressful situations but obviously seeing this many in that short a time is exceptional.

"This event is in no way over. We're still seeing patients directly related to this event coming in every day and we will for a while more to come."

Dr Jan Bone said patients were brought to Christchurch Hospital in cars, ambulances, on bikes, carried by strangers and even strapped to car roofs, during the 2011 earthquake. Photo / Supplied

Dr Jan Bone, a consultant emergency physician at Christchurch Hospital, will also speak to the symposium about her experience of the February 2011 earthquake.

In that event, communications had been wiped out, there was no way to know when paramedics would arrive with patients, computers were down and the power kept going out.

At one point, Bone sent student doctors to watch television news and report back what was happening outside.

Bone said it highlighted some minor flaws in the response plan such as headlamps not being readily available when aftershocks left the ED in darkness.

An important lesson was that doctors had to be flexible.

"The plan helps give you structure and you have to tailor it according to what's in front of you. You have to be fluid."

She said the earthquake followed by the shootings had left many staff unable to comprehend the enormity of the events and "people are really traumatised because of it".