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On the front lines of a catastrophe

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Dr Chhouy Meng, head of the emergency care unit and vice chief of the technical office at Calmette Hospital in Phnom Penh, spoke with The Post about his hospital’s emergency response to the tragic stampede on Diamond Island’s northern bridge.

Tell me about the emergency response at Calmette. Were you there?
Yes, maybe after nearly half an hour [after the incident], they called me and I came from home, and when I arrived already maybe 10 corpses had arrived in the emergency room.

How many people are at the ready for emergency response normally, and did you have to call in additional staff?
We have an emergency response plan, and we have an exercise also [to prepare] how to respond when many people come. So most of our staff knew what to do already. So when this happened, it’s a little better for us because we can take the person to the emergency centre, and some people whose injuries are not as severe we can send to an area already designated in advance. So we called our staff from other departments and asked them to help. Many staff from internal medicine and other wards came to help.

How many did you have to wake up in middle of the night?
We don’t have the exact number, and some came a little bit late – 20 or 30 doctors came.

Take me through your head on Monday night – what were you thinking?
We don’t ever expect something like this – so many people dead and injured. But for us, it was not so difficult in the technical aspect.
This accident that happened, the cause of the accident for most of the people was from difficulty breathing. I think that some people died because they are highly toxic [from a lack of oxygen], and they fell down and the crowd fell on them and they were traumatised and suffocated.

For someone who is not a medical expert, can you explain how someone suffocates in a crowd?

We asked all the people who were still alive what happened, and they said it was very crowded in a space that was maybe 50 square metres, with about 1,000 people squeezing against each other.
So the people in the middle of the crowd had difficulty breathing, especially the women.
All of the people in the middle of the crowd could not breathe, and that’s why that happened. For almost one hour people could not go back and forth. People who survived said it was difficult to breathe, and some people died because they could not breathe. Some were beneath other bodies because they fell down and then other people jumped over them.

What do you usually do when dead bodies arrive, and what did you do this time?
This time there were a lot of bodies and the problem with a disaster like this is the identification of the bodies. Some people may have ID cards in their pocket but some don’t, so we don’t know who they are. So the work to do immediately after that is to set aside the people who died and then identify who they are and inform their families. For the people who did not die, we treat them as we normally do any patient.
There were some interventions from other sectors including the Ministry of Health, soldiers, the police and security because immediately after [the accident] many people showed up at the hospital to see who had died, and the hospital cannot deal with this alone, so we needed the police to help.
But now it’s OK. We are back to normal. We’ve identified all the bodies and the government has taken all the corpses to their respective provinces. So now at our hospital we released all the bodies.

When a body arrives, how do you determine the cause of death?
For the dead people, some people who died were already identified by ambulances in the field. Some people who arrived in the hospital, we checked the pulse by feeling on the neck, and looking for their breath.

Can you be sure of the cause of death from looking at the body, or do you need an autopsy?
To be sure, normally you would have to do an autopsy but this is not normally done.

We heard of reports of electrocution. Did you see any signs of this, whether from injury or death?
There are some people who described this, but all the people who survived didn’t say anything about this. Maybe some people who tried to jump over the bridge into the water touched the electric wire. This is only in my mind [because] I haven’t seen it, but maybe one or two people touched the electric wire and when they tried to jump over the bridge and jumped to the water they described it but other people didn’t describe it. And especially when the people were removed by the EMT rescue team, there may be some electricity, but the lights on the bridge are normal, no abnormality. So I don’t think so, but maybe some people … but it’s not the cause of death or injury.

If someone is electrocuted, would it be obvious to see by looking at the body?
It is maybe not obvious. We cannot see by plain eye if the body [has been electrocuted]. Maybe if there is a burn, if the electric current is strong enough, there may be some burn on the body.

So could someone die from electrocution even if there is no obvious sign?
Yes, it might be possible. For the electric shock, if the current is strong, a high current, we may have some burn from contact with the current. But as I know there are some current intensities that may stop the heart without producing the burn, like they do in execution.

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