A success story from the Saving Lives in Sierra Leone programme

Context and challenge

Between 9pm and 10pm on 5 November 2021, a fuel tanker exploded in Wellington, at the eastern end of Freetown, Sierra Leone. The incident occurred when a truck hit a loaded fuel tanker, leading to leakage of the fuel. The situation caused a heavy traffic holdup at the scene. Scores of people, mostly motorbike taxi riders, apparently rushed to the scene to scoop up leaking fuel from the collision. While this was happening, and with the tanker surrounded by pedestrians, motorbike riders and vehicles, the fuel ignited, causing a fireball and explosion, immediately burning nearby vehicles, people and structures. In total 304 people were affected by the incident, with 87 deaths occurring at the scene or prior to admission.

Of the 159 patients seen in five hospitals, more than half had severe burns, many exceeding 50% of their body’s surface area. In any setting this would represent a low chance of survival. A further 66 deaths occurred in hospitals, reflecting the large number with severe burns.

There were multiple needs for these patients including an adequate supply of blood and blood products, pain relief, commodities, skilled plastic surgeons to carry out skin grafting, and psychological support for patients and staff. Many patients with burns of this severity need repeated surgical interventions to prevent, treat and mitigate disability. The livelihoods of many families and individuals have been affected.

Blood is an important requirement for severe burns patients, and freely donated blood has often been inadequate for routine needs. The blood fridges in Connaught hospital had not been functioning for some months prior to the event, and without these, safe blood transfusion could not be delivered.

Action steps and solutions

Many partners supported the emergency response with a national Incident Management Team (IMT) established and active within 16 hours of the event, building on training and systems put in place post-Ebola to respond to emergencies and the development of national capacity at the Emergency Operations Centre.

The referral coordinator and National Emergency Medical Service (NEMS) programme stepped up at the time of the event and assisted with routing of patients to and between facilities in and around Freetown.

In this emergency, blood drives in communities were publicised and run. There had previously not been use of plasma or other blood products nor the extended blood crossmatching required for patients undergoing multiple transfusions, but these were available across the time of need, and no patient was denied blood needed acutely or for surgery.

Following the repair of one fridge, and donation of another, two functioning blood fridges were made available at Connaught Hospital, through partner support from UNITE, PIH and WHO, coordinated through the National Safe Blood Services taskforce. These included voluntary blood drives by IRC, the UN Agencies, American Embassy, Freetown City Council, private companies and 150 units donated by individuals at static donation sites (sponsored by CUAMM). A significant legacy of donor blood became available following these blood donor drives.

WHO capacitated an Emergency Medical Team (EMT) from Senegal, while EMTs from the USA and Italy also supported the response. Commodities were inadequate in the immediate period of need at receiving facilities, but significant emergency supplies were brought in, including trauma kits from WHO, and these were rapidly disbursed by the logistics pillar through Central Medical Stores.

Results

• The IMT was functioning rapidly, led and coordinated by the Ministry of Health and Sanitation (MoHS) through Dr Kabba, (Medical Superintendent and surgeon at Connaught Hospital), Dr Jalloh (plastic surgeon and Case Management Pillar lead) and Dr Sandi (NEMS/Logistics lead).
• Blood drives were established, and 295 units of blood were donated, with, 92 units of blood, plus plasma and platelets provided by the National Safe Blood Service (NSBS) for burns patients.
• Two Sierra Leonean plastic surgeons, in recent years returned from training, were supported by the deployed EMTs to conduct multiple procedures, surgeries, and dressings for burns patients, and training was also provided by the EMTs to local staff on burns care.
• Psychosocial support was provided by a WHO consultant, for both patients and staff caring for the patients from this horrific event.
• Pain, antibiotic, nutrition, and other care protocols were developed, and medicines mobilised through multiple donors and, often, individuals.
• Ninety-three patients have been discharged, but sadly 153 people in total died, with many of those surviving having severe and life-changing burns injuries. Many will require repeated surgical procedures.
• Investments by FCDO on building emergency processes, referral systems and blood services, including coordination of donor and partner organisations were tested, and stood up well in the support of the response to this event.

Lessons learned

• Early activation of the national IMT ensured good coordination by MoHS pillars, and with donors.
• Rapid mobilisation of resources including blood drives mitigated the likely inadequate prepositioning of emergency medical supplies.
• Rapid development of protocols for elements of clinical care, supported by advice from UN technical agencies, partners, and the EMTs, ensured standardised quality care was provided.
• The referral coordinator programme and its linkage to NEMS contributed significantly to the initial response to this emergency.
• Despite historically low availability of donor blood, communities were able to be mobilised, and there was no shortage of blood for the clinical need.
• Deficits in blood fridge function were addressed and will capacitate the service in the future.

Recommendations

• Burns events following tanker spillages are not uncommon and are preventable through better road and vehicle safety, as well as education to communities on the risks of scooping up fuel that has been spilt from these vehicles.
• Scenario-based simulations and preparedness for emergencies needs to be a repeated training process, as well as an after action review of such events.
• The establishment of functional emergency units at hospitals, including for burns, with access to immediate commodities and free medicines in event of a mass casualty event, should be a priority.

Resources and reference materials

• 25 WHO/UN Situation Reports for the event
• NSBS taskforce minutes (December 2021) with record of donations given and received
• A systematic review of oil tanker truck disasters: Identifying prevention targets. Ewbank, C. et al. Burns 45 (2019) 905-913, doi: 10.1016/j.burns.2018.12.010

Montrose leads the Monitoring, Evaluation, Learning and Review (MELR) component of Saving Lives in Sierra Leone (SLiSL), funded by FCDO. This success story was originally published on the SLiSL website.

Image credit: Simon Davis/DFID (CC BY 3.0)