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Utøya 2011 – How to Meet the Unexpected

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Utøya 2011 – How to Meet the Unexpected Video http://www.youtube.com/watch?v=HpgjzGuHYFY Utøya 2011 – How to meet the unexpected. By head of municipal medicine Dr. Bernt Ivar Gaarder (Hole) Hole municipality •Tiny municipality – aprox. 6000 inhabitants. •Between Ringerike and Bærum close to Oslo. •Fast growing municipality. •Steinsfjorden, Tyrifjorden, Krokskogen. •Culture– 4 kings in the coat of armor. •Center located at Vik. •E-16 – tunnel-repare – detour via Neslandet. Ringerike emergency Some facts : 22. juli 2011 ward(6 munic., 60000 inhabit.) Ringerike Hospital (35 pas) Hønefoss Sundvollen hotel Utøya Owned by AUF Storøya/ Elstangen 550 m. From shore Triage2 Yearly Utvika camping summercamps Utøya landside 586 participants Triage 1 Oslo 40 km E16, detour 22.07.11. my experience of the start •From media- bomb in Oslo. • 17:48 Informered by the head of the emergencyward. •”shooting – several dead”. •Drives to Utstranda – speak with personal from the ambulanse – confirmed that 4 GPs are there at the scene (soon also medical rescue team - airbourne) •Returnes to “safe zone” – Sundvollen Esso – police gives the mission operative medical leader. CHAOS GATHER INFORMATION SYSTEMIZE INFORMATION MANY PARTICIPANTS HUGE DISPAIR AS A CLUE(THINK 700+ AT SUNDVOLLEN IN THE SAME CRISIS) Norwegian Health legislation •§ 3-1. The municipalitys main responcibilities for heath- and caretakingservices The mucicipality is obligated to see to that all people staying in the area within the municipality,are provided with necessary heath- and caretaking services. •§ 3-2. The municipalitys resposibility for healthservices. •3.Aid at accidents and other acute situations. •§ 3-5. The municipalitys role in emergency situations. The municipality shall imediatly offer healthservices to persons in need given these services are actually needed. The level of aid contains investigation, treatment and other help need that is proper for the municipality to offer Law on health and social preparedness (2000) Law on health professionals (1999) § 7. Emergency aid Healthworkers shall imediately provide the healthcare that they are capable of, when it must be assumed that the help is urgently needed. With the limitations given in the law on patient rights § 4-9, necessary health care shall be provided even though the patient is not able to give his concent. In doubt whether the health care is absolutely necessary, the caretaker is obligated to make futher investigations. This duty ceases when more qualified health workers take over the responsibility to give health care to the same person. The initial phases of the aid. Life support Place to be Understanding Whats going on? Acknowledgement Chaos 22.juli: 23.juli: 24.-26.juli: A The emerency- 26.-27.juli++: Orientation- place to gather phase Debriefing phase the relatives Victims! Organization When everybody goes home…. Stabilization -World outside Gathering information -Debriefing/therapy Increasing overview Establishment of an emergency reception 22.07.11. •Prehospital services transport the injured patients to hospitals. •The municipal emergency-team (chrisis-team) in Hole is convened. •A place to start to gather survivors, healthpersonel and relatives. •Sundvollen Hotel – essential for further handling. •First receive youth – heating, clothing and emercency psyk aid. •Food and sleep. •2 teams of surgeons outside. •Registration. Organizing •Municipal vs. National. •Prepared for this? •Trained for tunnel chrash, pandemic influenza and so on – not this! •Great desire to participate/help. •23/7 morning – wanted 20 – 37 met! Total over 250 ”profesional helpers”! •Head of medicine in Hole municipality – role as operativ medical leader located at Sundvollen – help from head of medicine in closest municipality – Ringerike. •LRS? (local rescue central) •Operativ medical leader in a commando-central together with the police. •Teams with different professions (priests, psycologists, doctors, nurses imams etc.) devided in groups around the clock 24 hours a day. •Individual therapy and group therapy. Equipment •Hole farmacy on call to deliver medication and medical equipment. •Hole medical center and the local emergency ward in generel preparedness. •Local tiny “emergency ward” at Sundvollen hotel. •Red Cross and others left equpiment , blankets and more. •Journalsystem – needed a system that could be used by different healthworkers. •Storage-obligation. •System x- from Kongsberg came and made a system during the night! •Database problems. Volunteers (uniformed vs. nonuniformed) •”Boatpeople”. •”Campingpeople” •Sundvollen hotel. •Locals that took in survivors temporarily (before Sundvollen Hotel). •Red cross. •Sivildefence. •Funeralhome-staff. •Volunteer-center. •People that just came. •”Ask me”. Media and visitors •Enormous pressure from media – constantly telephones from CNN, Stern, local media etc. •Choice – concentrate on work and let all information go the mayor in Hole and the mediadepartment in the police. •Save the youth from the media more ? • Visitors - politicians, royal family, national health department etc. •This creating a need for security and for informationsbriefing. A place for relatives •Within the first 24 hours most survivors go home. •But relativs of the missing youth keep coming – still a need for a place to be. •Informaton x 2-3 a day – gatherings (local police, Kripos (invastigating police) and health representatives). •Soon info about numbers of missing persons – a number that will be reviced later. •Info that there is little hope of remaining survivors amongst the missing. •Kripos (police) – interview og DNAtesting for identification. •Chrisis-help to relatives. Action taken outside the hotel •Quickly dicovered a need for help and debriefing of exposed ”groups”. •”Boatpeople”, ”campingpeople” and refugees. •Unique experiences – many felt the put their life at risk. •Strong impressions – magical thinking /impossible choices. •Debriefing and info in several rounds. •Initially we tried to find exposed people. •Continued evaluation of the need for assistance/help. Termination of Sundvollen as a place for gathering. •After the weekend – more and more go home after their talks with Kripos (police). • Ment to give acute help –no long term ”psycotherapy” here. •After Kripos (police) is done – people are moved to Rikshopitalet in Oslo. •They took over our journalsystem. •Now all journalsystems back in Hole municipality for storage. Debriefing. •Asked the national healthdepartment for help to organize good debriefings og the helpers. •Hotelstaff, medical healthworkers, Red Cross,municipality workers, leaders of local firedepartment and others involved. •Atle Dyregrov and Anders Smith. •Homogenous groups exposed to similar situations appoximately at the same period of time in the chrisis. Facts • Just under 700 participants at the island. • 58 to hospital. •Initially Ringerike 35, Bærum 7, Drammen 1 and Ullevål 15. •Some then flown to Rikshospitalet. •69 died– 65 killed at Utøya, 2 died at the harourside on the mainland, 1 drowned og 1 declared dead on arrival at Ullevål. •32 of the dead under 18 years old, youngest 14 years old. Aftermatch •Relatives of dead living in Hole – their own followup. •Previous discussed groups continued for a long time and some still continuing. • Kindergardnes and schools had a program. •Trips back to Utøya. •Critisism: ”Is this tragedy worth more than others?” •Contrast between recomandations with activly seeking up people/ forms to fill out from the national departmens and statements from experts claming that to tight followup can makethe patient more sick than he is – dont pathologise. •Regardless – those in need of help will get the help they need! Reflections today – learning 1. The historical perspective «Everyone should be judged from what conteporary information 2. How to put the limit for security they possesed at the time» – what to plan for? «When a softice becomes a threat…” Evaluations. •If praise – nice BUT remember – hard to face critisism – police. •Several ”owners” of the truth – their truth – thereby several thruths – and thats ok! •Many evaluations. •22 juli commitionen. •Timeline/information. •Reflection/experience. •Learn! Some of Hole municipalitys conclusions •Small municipality vs. National catastrophy. •Though not prepared – managed to get by. •Enormous will to participate and to cooperate. Importance of good knowledge of local information. •The huge meaning of Sundvollen hotel. •Stood in the tough situation – give those that need help the help they need. •Revice plans. TakkThank for you meg! Questions? .
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