CoI into deadly Mahdia fire: More medical help would not have reduced death toll – Burn Care Unit Head

Calling it the most tragic event in his career, Head of the Burn Care Unit at the Georgetown Public Hospital Corporation, Dr Shilindra Rajkumar believes that increased medical human resources could not have decreased the death toll on the night the Mahdia dormitory was set alight.
The second public hearing of the Commission of Inquiry to probe the events of the Mahdia dormitory fire commenced on Friday with the testimony of the burn and plastic surgery specialist, who recounted his role as a first responder.

Dr Rajkumar told the commission that of the 50 girls who required hospital care, only one succumbed to her condition – despite every effort to transfer her to the GPHC for advanced care.
He opined, “No, to be honest, the persons who died, died in the fire. So, medical personnel would not have helped there. And of the patients who made it to the hospital, they all went home safe [except] for one patient who died. If we look back at the numbers, there were 15 patients who needed hospital care, 50 students in total who were reviewed. Of that number, only one person died…I don’t think more medical help would have reduced the mortality.”
Giving an assessment of medical resources on the ground, the Commission was told that doctors and auxiliary staffers on site did the best they could in such tense circumstances where there was a sense of overwhelmingness. Additional resources could have been deployed here to relieve those who were working for long hours.
“I think they were overwhelmed. It was a lot more than they were accustomed to, or they were prepared for. But they mostly, with them being limited in the numbers and the resources, they did a pretty good job, us dealing with the situation and I think it was a difficult situation. But I think they did well. I think the best they could with what they had.”
“The staff was overwhelmed. They were asked to do shifts and were 24 hours without sleep. That’s where additional help would have been of benefit,” the doctor underscored.

Recount
Before midnight on May 21, the Burn Care Unit Head recalled receiving instructions to lead a team to Mahdia, having received word that a school dormitory was engulfed in flames.

Four doctors and a nurse were under the instruction of Dr Rajkumar. Making a rough calculation, the doctors mobilised to gather supplies and emergency kits that would be needed in a mass casualty situation.
“Everything was put together and we were transport to the Eugene F Correia Airport. It was very busy. There was a lot of people helping us to unpack. The President was there. We were placed into the aircraft in a matter of minutes.”
Arriving just after 03:00h at the ‘chaotic’ airstrip, the team headed over to the Mahdia Hospital, where they were greeted by hundreds of bystanders around the facility.
Some 20 females were at the Mahdia hospital; six in the treatment area with minor burns. A majority of the others were in another area; two to three persons were sharing a bed but not in immediate danger or injured in any way.
Three children were identified as severe cases, according to Dr Rajkumar. The first was experiencing an ‘altered state of consciousness’ and on the verge of a comatose. Doctors suspected that she was suffering from carbon monoxide poisoning.
“From anything below eight is considered comatose. She was scoring nine so she was responding only to painful stimuli…We suspected that her condition would have been due to carbon monoxide poisoning based on the history of her being exposed to smoke and she had to inhale that burnt material. She did not have any significant burn to render her in that state. The highest diagnosis on that list would be that she was exposed to carbon monoxide which depressed her mental state.”
From indications, responders indicated that her brain was most impacted, since carbon monoxide poisoning affects the airways, lungs and brain. It can also impact the heart. The second child suffered from about 30 per cent burns about the body, and in visible pain. She had burns to the back, lower limbs, arms and chest.
“We refer to burn based on the depth of the skin that the injury has penetrated… She had varying depths of burn; 25 per cent of it was second- and third-degree burns and 15 per cent, superficial burns.”
Another student had 11 per cent deep burns with inhalation injuries, having being exposed to hot gas. This affects the lungs and airways.
He shared, “They were exposed to hot gases from the fire itself. Breathing in hot gas can cause burns on the airway down. In addition to the heat, the products of combustion, the soot, the chemicals that arise from the furniture, there is also a component of chemical injury on the airway.”
A decision was made to transfer these three patients to be medevacked, having gauged the severity of their injuries. Three other patients were already en route to Georgetown; where one of them was already comatose and died several days later under intensive care. She was the 20th person to die from the Mahdia tragedy. It has been reported that 14 youths died at the scene of the fire, while five died at Mahdia District Hospital.
The Mahdia Hospital is a single flat facility, with about six rooms utilised during the emergency, some of which were not designed for patient care and repurposed to deal with the situation at hand. Hours after, the survivors without injuries were cramped into a small space, with no clothes or place to sleep properly.
The GPHC Unit Head said to the CoI, “There were 10-12 students in a room and there were people going in and out checking on them that didn’t need to be there; they had no injuries. The problem was they were brought to a hospital because their dorm was burned down. They had nowhere to go sleep and no clothing. That was very stressful for them. To have them in an environment that had the patient care happening actively was impacting them, as well as impacting the function of the medical staff.”
He assisted with ensuring they were properly accommodated by moving them to a COVID facility within the compound.

Medevac
Meanwhile, Captain Learie Barclay attached to Roraima Airways was one of the pilots who took charge of navigating through the darkness to reach Mahdia, transporting the medical team and airlifting those injured to Georgetown.
Quite frequently, Barclay told the Commission that Roraima Airways is called to respond to critical medical evacuations. Barclay said he was notified at about 00:20h that he was needed to facilitate a night medevac.
Operating in ‘pitch black’ situations, he noted that they heavily rely on instruments inside the aircraft to determine coordinates and other critical information. In many cases, he noted that runways in the hinterland regions are unprepared and not properly lit. However, he managed to land safely that night and despite the chaos on the airstrip, first responders were able to execute their job.
“In this case, it was clear that the resources that they had were depleted and they did the best that we could under the circumstances. It was good enough for me to be able to identify the beginning of the runway and the end of the runway and the width,” the Captain recalled.
At 5:45h, three girls were brought to the aircraft by ambulances. He recalled the condition of the third girl, who experienced no burns but was severely affected by smoke inhalation. She was taken off the aircraft several times and had to be intubated.
“That was a little traumatic for all of us around. The process of intubation is not a pleasant one to see…It is not a pleasant procedure, particularly children. [The other children] were crying and moaning in pain.” (G12)