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Specialists from the Center for Disaster Medicine tell their
Written by Åëåíà Âðàíöåâà   
Âòîðíèê, 29 Îêòÿáðü 2002
“We sorted according to the principle of ‘alive — not alive’.”
 
In ‘Gazeta’, October 29th, 2002
 
 
What was the plan during the hostage rescue, and under whose leadership did the physicians work? How did they coordinate this work, and was it possible to avoid so many fatalities? Specialists from the Center for Disaster Medicine discussed this with ‘Gazeta.ru’. The medics’ point of view, however, is at odds with the official one.
 

Direction of physicians during the rescue of the ‘Nord-Ost’ hostages was entrusted to Andrei Seltsovsky, the head of the Moscow health department. He developed plans, strategy, and tactics for the physicians. Operational management of the situation was delegated to his deputy, Professor Lyudmila Kostomarova, the director of scientific practice at the Center for Emergency Medicine. She appointed coordinators — the leaders of the medical teams who were responsible for coordinating the actions of physicians on the scene during the hostage crisis.
 
- Immediately after the assault, which medics assisted the newly freed hostages?
 
“Emergency Ministry rescuers, medics from the Moscow health department and the civil defense directorate from Moscow's eastern administrative district, and many others,” recalls Yuri Pavlov, chief of medical evacuation at the Center for Disaster Medicine (CDM). “We weren’t allowed into the building after the assault, because they feared an explosion. Already on the evening before we’d guessed that there’d be an assault. Obviously, something was up. Another 20 ambulances had driven over, but none of us were warned about an assault. We didn’t know what they’d use to free the hostages, and what medications we’d need to prepare. The (CDM) specialists warned the head doctors of the nearest hospitals in advance, so that they’d to free up some beds. They even discharged patients from intensive care.”
 
- What sort of orders did you get from the team coordinators, and how often?
 
“We were in touch every 15 to 20 minutes. We had radios. The coordinators moved us around and made team changes. I was with the organizers coordinating communications for the CDM specialists and other medics.”
 
- What criteria were used to select hospitals?
 
“Distance and specialty. We’d prepared for blast injuries. As far as I know, there weren’t any specific recommendations to stock certain drugs. Usually hospitals have enough on hand for 5 to 7 hundred casualties, as well as enough specialists and intensive care facilities. They’d need to stock up if it came down to, say, two thousand simultaneous casualties.”
 
- What were your actions when they started carrying out the hostages?
 
“I was in the courtyard of War Veterans Hospital No. 1. When I heard on the radio that there weren’t enough doctors, I ran over to the main entrance of the building that had the hostages, where on the ground they were collecting corpses and placing casualties to be sorted. Rescue workers, as well as soldiers and policemen were carrying out the casualties. It was as if the people were drugged. At first glance I got the impression they people had been ‘shooting up’.”

 
- Were only specialists involved in sorting people?
 
“I think so. Only medics. Sorting is diagnosis and determination of the severity of a casualty’s condition. We sorted them on the square, according to the principle of ‘alive — not alive’. Our trauma surgeon was with me, and we did about 50 to 70 people. Even the specialists found it difficult to determine if people were alive or not. Breathing was very compromised. It was almost absent, and people were in a state of inhibition, in a coma. The situation wasn’t very calm, either. A very large number of people went through. We checked the pulse on the carotid artery. We had no time to connect casualties to a heart monitor. If we got in deep with one, we couldn’t have helped ten. Later we got orders on where to take them.”
 
- Who determined to which hospitals they would transport a person, and how did they determine this? Did you determine this?
 
"I did. Movement was extremely compromised — there was a large cluster of various special-purpose vehicles. They blocked each other on the road. It was necessary to get them moved. We couldn’t get any information about how full the hospitals were. Every minute we sent off two or three ambulances. I had a rough idea about the number of casualties we’d sent off and bed counts. I took a guess on where to send them. About 100 casualties were carried over to the Veterans Hospital. 200 were sent out by ambulance, and about 400 on buses. We put on the buses those who were mostly able to move on their own. The last of these buses we used to transport the corpses.”
 
- Why were so many hostages stripped to the waist?
 
“I think they were searched. They checked to see if they had explosives belts. Before leaving, we didn’t inject them with antidote in the sorting area. We only sorted them and loaded them into ambulances. The medics worked hard, and selflessly. What could be done — was done.”
 
- Did the medics instruct the commandos on how to properly carry people, or teach them other things?
 
“No. The commandos worked according to their own algorithms. They got the order to carry everyone out, and they carried them however they could. I shouted at them whenever I saw any mistakes. I told them elementary things, for example, how to more carefully carry people, but the atmosphere was such that they didn’t respond to anything. They didn’t seem to hear me.”
 
- You knew that people with such poisonings could only be carried over your shoulder, or else the victim could die?
 
“Of course.”
 
- What are the possible consequences of overdosing with the antidote?
 
“Virtually none, except for slight dizziness. The antidote blocks the body’s narcotic receptors, and removes it from the body.”
 
- In your estimation, when were there more deaths — immediately after the assault, or during transport?
 
“Perhaps equally.”
 
‘Gazeta.ru’ also spoke with Lyudmila Pakhomenko, director of the Moscow territorial CDM. First she rescued victims in a mobile intensive car vehicle, and later worked in the hospitals.
 
- Did you have antidote?
 
“We only had trauma and resuscitation packs. (There was) IV solutions and tubing, and the cardiovascular kits had boxes of caffeine, enough for up to 20 people. We only revived one woman, however. She was unconscious, in a coma. We did intubation, that is, we put in a tube to restore breathing. She quickly regained consciousness and began to breath evenly and opened her eyes. We took her to Hospital No. 13. Then we went to Hospital No. 84. They didn’t have enough intravenous lines and fluids. We brought our supplies there. At this time Melnikov (street) had about 300 ambulances. Many of them were idle. They didn’t let us drive up to the building where they we carrying out hostages — they were afraid of an explosion. It looked like they didn’t need us there.”
 
- So, if they loaded two or three people at a time on these 300 ambulances, and performed those actions that you used to save the woman, would most of them have survived?
 
“I think so. But as to why they didn’t do this, now that’s a good question.”
 
 
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