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An MChS (Emergencies Ministry) employee tells about the events
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, 22 2003
By Vladimir Perekrest and Elena Loriya


The lessons of 'Nord-Ost': Had military physicians been on call at Dubrovka the number of deaths would have been several times less

On Sunday it will be exactly one year since the assault on the theatrical center at Dubrovka. During this time a lot has been said about those guilty and innocent in the deaths of people, about whether the assault was really necessary or if things could have been settled without one. Today, however, something else is important not to look for scapegoats, but to take away some lessons from 'Nord-Ost', so if something similar, God forbid, were to repeat itself, we could try to avoid such a large number of deaths. After all, these days practically everyone, officially and unofficially, admits that the loss of most of the hostages was directly related to the abominably organized provision of medical assistance.

What happened with the former hostages at Dubrovka does not make sense, especially if one considers that during the two Chechen wars Russia accumulated colossal, though bitter, experience in providing emergency medical assistance to mass casualties.

Back then, on
October 26th, 2002, Moscow did not need ambulance physicians who did not know what had happened to the hostages or what was the diagnosis (and who as a result ended up playing more the role of taxi drivers than physicians). Theydid not even need the MChS rescue workers. Whatthey needed were physicians in epaulets: military medics who were used to dealing with any influx of wounded and other casualties, and who knew how to precisely allocate this influx.

Now, a year later, many specialists agree on one thing, that people should have had medical assistance on the spot and not been removed from the hall. This, however, is only theoretical. After all, for a long time after the assault there was still the danger of an explosion, and the evacuation was unavoidable. Butbeyond the boundaries of the theatrical center there should have been preliminary or other organized medical assistance.

Nothing new needed to be thought up. Everything has already been thought up before, says Vyacheslav Moskalenko, the head of the surgical department at Armed Forces Central Military Clinical Hospital #5. Hehas been through
Chechnya. The first thing that needed to be organized were sorting areas (for triage ed.) Every military hospital conducts yearly training modeled on similar situations, even imitating the rapid influx of patients. Onthe sorting area should be experienced duty physicians to allocate the casualties. Every arrival is tagged, and later, depending on this tag, he is either sent to intensive care, or to surgery, or, to nowhere in general.

In the case of Dubrovka they could have set up several tents beforehand: one for surgery, another for intensive care and resuscitation, and a third for the least critical patients with only nurses fully capable of injecting the antidote. Alsoneeded would be soldiers and regular medical stretcher-bearers. After all, since no one had thought to bring stretchers and slings, people had to be carried out from the theatrical center in the rescuers' arms.

Large, 15-man medical tents can be set up in 17minutes, says Vyacheslav Moskalenko. They needed to act according to the canons of military field medicine, and do only a few elementary things: first allocate the flow of incoming people, second create several sorting areas and place experienced physicians there, third illuminate this area under spotlights, and fourth begin assistance on the spot. Itonly seems that 800persons are a lot. Infact, five sorting areas could have fully handled such a flow.

No one sorted the injured at Dubrovka. Thehostages, half-naked and unconscious, were piled into cold buses where they waited a long time to be sent to the hospital.

My daughter was simply crushed under the bodies of other people in the bus, remembers former hostage Svetlana Gubareva. Had they immediately provided assistance, Sasha would be alive. Whydid they have to take her to a hospital? Itwould have been sufficient to inject the antidote on the spot.

Assistance on the spot, it turned out later, could have been the most elementary. Thegas that they released into the auditorium was not toxic, but a sleep-inducing agent. Manyof the hostages did not die from poisoning, but from falling asleep and choking on their own tongues. Thesimplest of devices, the 'Ambu' bag, could have saved them. Itis used to force air into the lungs and it is found in large quantities in all medical stockpiles. Taking all the casualties to hospitals was senseless. Someliterally died in only a few minutes, and assistance to these people had to be immediate.

Here they did not need the SMUs (special medical units Izvestiya) that work in
Chechnya. Itwas fully possible to make do with just the physician and nursing teams that provide assistance to citizens in the case of terrorist attacks and various technological and natural catastrophes, says Vyacheslav Moskalenko. There are such teams in the army, and these specialists have medical kits with all needed medicines for various scenarios. Ingeneral, the military medical service could have managed this mission with no problem. Ifthe operation was conducted by the military, then Ido not understand why they left the medical part to the civilians. Theysimply do not have the same experience.

We were prepared to pull people out from under rubble

We had no information what sort of substances they would use in rescuing the hostages, said an MChS worker who was working on the night of the assault on 'Nord-Ost'. What was used was a complete surprise for us. Wewere prepared for an explosion of the building, and proceeded from that prognosis of the situation. Theytold us that there were more than 100kg of explosives, and in the case of an explosion only ruins would remain of the building. Thepreliminary mission we were briefed on was along the lines of: prepare to pull people out from under rubble. Weprepared the corresponding equipment. Weknew nothing about the fact that they would use a special substance, and knew nothing about what kind it was, how it effected a person, or what sort of an antidote was needed. Moreover, from the signs Ican say that even our minister did not know. Makeyour own mind up: if they did not notify us, then Iam not certain that the medics were notified, either. Thismeans that they had never prepared for such a situation. Thespecial services classified everything as secret, even from those who were directly tasked to rescue the people.

As far as any kind of training exercises imitating a situation analogous to 'Nord-Ost'," continues the MChS officer. They have never taken place that Ican remember. Butthe level of preparation of our rescue workers is sufficient to allow them to provide people with absolutely any type of assistance, if we have been adequately informed about the character of the incident. Soit would not be like this, speaking figuratively, that we are called to rescue people from the aftermath of an earthquake, and it turns out to be a flood. Wehave experience higher than the roof, so Idon't see any special problem if we haven't done any special training along the lines of a 'Nord-Ost' situation. If, God forbid, something like this happens again, then the success of the operation will depend on who is in charge. Ifthey manage us during such a big operation as they did a year ago, then Idon't know what to expect.

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