Planning of surgical resources in disaster settings

Abstract

In October 1991, the education of nurses begun (anaesthesiology, intensive care, surgery), the list of essential medicals and supplies was created, needed quantities were calculated,“The plan of pharmacotherapeutic treatment of wounded” was written and entrusted to Topusko War Hospital. Education of general and emergency medical teams was planned but not implemented. In the hospital, technical provisions (space, beds, supply of gases, electricity, and water) were taken care of before the attack on Karlovac. Some organisational and expertise problems were taken care of during the war. There was a shortage of surgeons, anaesthesiologists, anaesthesiology technicians, nurses, physiotherapists in emergency admission, surgery, and ICU. Doctrines and knowledge of war medicine were missing. The approach to triage and care of wounded was not always standard. Particular problems were resolved in contacts with clinics. Hospital infections were more frequent. Burnout syndrome was also present. Donated medicines and medical supplies ware often wrongly distributed. Many pharmaceuticals were not used in Croatia, many were out of date and some were undersupplied. After the Homeland war, experiences, knowledge and problems were largely forgotten and physicians working during the war retired. With the advent of Covid-19 pandemic, medical staff organised their work, prepared resources and doctrines. The number of anaesthesiologists was not adequate. As in the war, there was a lack of anaesthesiology and intensive care nurses. Many problems were again solved on the fly. Working hours were increased as well as work intensity with psychical burden due to hopeless situations, lack of knowledge and skills. Burnout syndrome was again present. Teamwork was burdened by problems. It was necessary to establish conditions for the surgical work in specific circumstances. Healthcare system needs to be systematically and continuously prepared for the operation in disaster settings.