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Specialists from the Center for Disaster Medicine telltheir
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, 29 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? Howdid 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’. Themedics’ 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. Hedeveloped 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. Sheappointed 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 20ambulances had driven over, but none of us were warned about an assault. Wedidn’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. Theyeven discharged patients from intensive care.”
- What sort of orders did you get from the team coordinators, and how often?
“We were in touch every 15to 20minutes. Wehad radios. Thecoordinators moved us around and made team changes. Iwas with the organizers coordinating communications for the CDMspecialists and other medics.”
- What criteria were used to select hospitals?
“Distance and specialty. We’d prepared for blast injuries. Asfar as Iknow, there weren’t any specific recommendations to stock certain drugs. Usually hospitals have enough on hand for 5to 7hundred 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. WhenI heard on the radio that there weren’t enough doctors, Iran 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. Itwas as if the people were drugged. Atfirst glance Igot the impression they people had been ‘shooting up’.”

- Were only specialists involved in sorting people?
“I think so. Onlymedics. Sorting is diagnosis and determination of the severity of a casualty’s condition. Wesorted them on the square, according to the principle of ‘alive not alive’. Ourtrauma surgeon was with me, and we did about 50to 70people. Eventhe specialists found it difficult to determine if people were alive or not. Breathing was very compromised. Itwas almost absent, and people were in a state of inhibition, in a coma. Thesituation wasn’t very calm, either. Avery large number of people went through. Wechecked the pulse on the carotid artery. Wehad no time to connect casualties to a heart monitor. Ifwe 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. Theyblocked each other on the road. Itwas necessary to get them moved. Wecouldn’t get any information about how full the hospitals were. Every minute we sent off two or three ambulances. Ihad a rough idea about the number of casualties we’d sent off and bed counts. Itook a guess on where to send them. About 100casualties were carried over to the Veterans Hospital. 200were sent out by ambulance, and about 400on buses. Weput on the buses those who were mostly able to move on their own. Thelast of these buses we used to transport the corpses.”
- Why were so many hostages stripped to the waist?
“I think they were searched. Theychecked to see if they had explosives belts. Before leaving, we didn’t inject them with antidote in the sorting area. Weonly sorted them and loaded them into ambulances. Themedics worked hard, and selflessly. Whatcould be done was done.”
- Did the medics instruct the commandos on how to properly carry people, or teach them other things?
“No. Thecommandos worked according to their own algorithms. Theygot the order to carry everyone out, and they carried them however they could. Ishouted at them whenever Isaw any mistakes. Itold them elementary things, for example, how to more carefully carry people, but the atmosphere was such that they didn’t respond to anything. Theydidn’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. Theantidote 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) IVsolutions and tubing, and the cardiovascular kits had boxes of caffeine, enough for up to 20people. Weonly revived one woman, however. Shewas unconscious, in a coma. Wedid intubation, that is, we put in a tube to restore breathing. Shequickly regained consciousness and began to breath evenly and opened her eyes. Wetook her to Hospital No. 13. Thenwe went to Hospital No. 84. Theydidn’t have enough intravenous lines and fluids. Webrought our supplies there. Atthis time Melnikov (street) had about 300ambulances. Manyof them were idle. Theydidn’t let us drive up to the building where they we carrying out hostages they were afraid of an explosion. Itlooked like they didn’t need us there.”
- So, if they loaded two or three people at a time on these 300ambulances, and performed those actions that you used to save the woman, would most of them have survived?
“I think so. Butas to why they didn’t do this, now that’s a good question.”
 
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