A call for massive casualty turned out to be a terror attack scenario, with tragic consequences. It was just breaking news at the TV that the emergency medical services crew discovered to be a very dangerous and dramatic situation.

The #AMBULANCE! community started in 2016 analyzing some cases. This is a #Crimefriday story to learn better how to save your body, your team and your ambulance from a “bad day in the office”!

Terror attack: the story of a first responder

Our protagonist grew up in the slums of Nairobi where there was always chaos everywhere and almost everyone’s dream was to be a gangster, drug dealer or drug addict just to mention a few.  After High school he did not join college to engage himself in volunteering activities as a member at St. John Ambulance.

They would engage in First Aid Trainings, Community service, Competition, Hospital visits, outdoor activities among others. This is where he started the journey into EMS.

“At the time of the case, he was an Emergency Medical Technician-Intermediate by profession currently working for the Kenya Red Cross Society-Emergency plus Services. His job was to respond to various emergencies, be it from road traffic accidents, mass casualty incidents, home emergencies and inter-hospital transfers. The dispatch center is the main communication center between the ambulance crew internally and to other agencies such as the police, firefighters etc.

THE CASE – All the years I thought I knew terrorism only to find out I had no idea at all. It was on Saturday 21 September 2013. I have had other terrifying incidents but this I can never forget. At that time I was working for another private agency that mostly deals with hospital transfers. It was around Midday while we were sitting in the lounge watching TV.

Suddenly the program was interrupted by breaking news ‘Thugs shootout with the police at West Gate mall’. We didn’t take it seriously since it wasn’t something new so we continued with our stories. After a few minutes, the Ambulance supervisor received a call from a medic (ex-employee) telling him that they were overwhelmed with casualties at the West Gate Mall and the situation was worse than we thought and if we could assist.

Terror attack: what happened

During that time, the hospital I was working with didn’t usually respond to emergencies outside our area but this seemed to be more than the usual incidents. My supervisor called me and requested a nurse from the hospital so that we go and check it out.

As we were approaching, the environment already gave us a picture of the magnitude of the incident and confirmed that it wasn’t what we were thinking. Sirens all over from every side, regular police and the General Service police had cordoned off the area.

What confirmed my suspicion is the presence of army which was not usual unless the threat is of high level. The Asian community (which is the majority in the area) with the help of their community vigilance had already secured un exit and entry routes from the scene to the nearby hospitals. They were well organised with volunteers manning the roads and had established a triage area in a nearby temple. the also have their communication center to aid evacuations.

As we were entering, I saw the police evacuating civilians, uninjured and the walking wounded. As we approached the Hot zone I could hear shots all over and everyone trying to take cover. No sooner had we parked behind another ambulance than louder shots were heard like drum beats, everyone started running for their lives. My supervisor (also the Driver) ran and took cover under the Ambulance, that’s when reality hit me that this was real and not what I was used to, I quickly followed him.

The shots stopped after some minutes, I could see the everyone peeping and others shaking in fear. We regrouped and watched using the Ambulances as cover since they were parked just in front of the entrance to the building. At around 1400hrs some policemen came out shouting “Ambulance, Help over here” we looked if the Ambulance crew that was ahead of us but they were nowhere to be seen so we had to go into the building after the police. They told us to keep our head low and follow them but they didn’t offer anybody amour.

As naive as we were, we went inside the mall to rescue patients, I had never seen so many bodies and blood as I saw that time. They were killing anyone they came across children, mothers, men even the old. I got confused a little and stared at the lifeless bodies lying everywhere, for a few seconds I was lost in my mind, confused and not knowing what to do. Suddenly my colleague pulled me out of it. We were taken to a café nearby.

We jumped over a few bodies and from behind the counter, there was a white young man with blood all over the shoulder. We loaded him on the spine board rushed toward the Ambulance. He had a gunshot on the right shoulder, we dressed him an evacuated to a nearby hospital. We finished a returned to the scene.

By this time the Kenya Red Cross had set up, a disaster kitty and Kenyans were contributing cash, foodstuffs and anything that could help. At around 1700hrs we were called to respond again, this time the casualty was on the 2nd floor so we had to go via the parking. More bodies of mostly children which I later came to learn the children had a cooking competition at that part of the parking.

This time the police came out with a man, middle age, Somali ethnic with multiple gunshots wound. I heard them saying that they suspected he was among the terrorists because they had evacuated almost every casualty and he was among the lasts not to forget his race.

The police officer there at first refused as access because they wanted to interrogate him but we argued that they could do so once we stabilised him. One of the senior officers told us they have to accompany us since they had information that the terrorist was escaping us, civilians. They interrogated him as we were treating him, he had lost a lot of blood so we told the police we can’t delay any more but it all fell on deaf ears. One of the police stayed to accompany him to the hospital.

Upon reaching the exit we were ordered to come out of the ambulance so that they could inspect, harrassed us to produce our identity since we were all Muslims and the nurse I was with was off Somali origin. we provided our Identification cards and job card but they still harassed as for some minutes. They asked the victim to state his business at the mall in which he stated that he had he was a driver and he was taking his employer’s two daughters for shopping at the mall.

Tears were flowing from his eyes as he explained how he couldn’t save the children after being shot, all he could do was playing dead as he watched the girls lifeless bodies beside him. he gave out his employer’s details so as to confirm his story. The police kept on asking as to why were trying to save a terrorist, we simply answered we don’t judge who we save or not but I could see they were not happy with either the response or us. We managed his bleeding, gave painkiller, started fluids and evacuated.

The casualty kept on pulling my hand telling me that he was innocent and a victim of the attack, All I could do was reassure him. He was going to die and wanted me to find his keens. He kept on saying the Kalima (declaration of Islamic faith, it is believed that if ones the last word is the kalima, then he/she would go to paradise). We evacuated him to a nearby hospital, handed over to the medics and the policemen escorting him even to the operating room. I was so touched and deep in my heart believed he was innocent but it wasn’t my place to declare so.

For the next few days, I kept asking myself a lot of questions like if there was anything else I could have done, if am right he was innocent if he was still alive among others. Also, I kept praying of the truth to come out soon before anything happens to him if he was truly in. After that we were tired so we proceeded to the resting area.

We stayed there until midnight since there were no casualties being evacuated for some hours we decided to go home. The operation went on for three more days but since there was not much need for us we did not go back
A few days after the incident, I was very happy when I saw the man (one who was suspected as a terrorist) on the television being interviewed about his encounter and how he came to be released after being found innocent. He spoke of how grateful he was at us and how we managed to save his life. I felt relieved us for days I had been asking myself what became of him.

The operation took 4 days with fatalities standing at around 70 fatalities or more, over 200 injured. Some civilians were trapped inside the mall for as long as the entire period before being rescued. The Government reported having gunned down 4 attackers and condemned the attack on innocent lives. The operation was helped by external forces including the FBI and Israel forces since the Mall had had people from a lot of countries especially United States and Israel nationals among others.

The Extremist Islamist Group Al-Shabaab claimed responsibility of the attack claiming was a retaliation of the deployment of Kenya Military forces into their territory, the neighbouring country of Somalia since 2011.

Terror attack: Analysis

I gained ala lot of respect for the Sec. Gen of Kenya Red Cross for being on the front line in evacuating victims and going out of his way to do it by himself. Kenyans became united to aid the victims and volunteering in any way possible. Kenya Red Cross did everything they could do to help and used every resource at their disposal.

• EMS agencies responded from every corner and worked together which was very different from that norm since we were always competing.
• We as the EMS were not really experienced in such incidents but we responded well and worked together towards a common goal.
• There was no clear guideline in ICS protocols nationally.
• There was some misunderstanding between the local authorities and the army on who should be in charge of the scene which gave time for the terrorists to regroup and cause more harm
• We as the EMS teams were very close to the Hot zone hence within the firing range. We also went into the mall without safety amour while the police had their helmets and bulletproof vests. we were not safe at all
• We had been told to park near the entrance which really exposed us.
• If it wasn’t for the local Asian community security in controlling traffic and mobilising things then there would be a lot of confusion. this should be the work of the authorities
• The safety of the public was at risk since the Police and Army didn’t check those who were coming out of the mall until after like 6hrs which I think if the terrorist were to disguise themselves and hide among the public it would have been successful.

There were reports that the authorities had the intelligence of an imminent attack but didn’t prepare adequately. I think the government failed us this part.

AFTERMATH – Kenya Red Cross with the help of Kenyans on twitter with the trend #weareone managed to raise a lot of money in the disaster kitty that was used to:
1. console affected families, mobilise resources, establish Psychosocial support to both the victims and responders to deal with the post-trauma stress among others.
2. Established Tracing center for allected families to trace where their victims were hospitalised, tracing the lost and the bodies of there loved ones
3. Also, some funds were set aside to compensate for the responding agencies.
4. Organised a retreat event for the responders to have fun and recover from the event
5. Supported some of the victims to start-up business f.ex opening a shop for one of them at the Red Cross hotel premisses.
-We as EMS family learnt a lot and agencies with the help of Kenya Red Cross and Kenya Council of Emergency Medical Technicians came up an action plan to make responders ready in case of future Multiple Casualty Incident and encouraging ICS knowledge.

-Formation of National Disaster Management Unit
-EMS was recognised by the government and so far we are growing in number and strength.
-There were also organised meeting for EMS who responded for briefing, sharing stories and coming up with what went wrong and plan for future incidents.
-The government came up with policies, clear guidelines and structure in case of another disaster.

Terror Attack: Conclusion

There was a risk that should have been avoided if the ICS protocols were followed: I think if there were clear protocols set up in case of an incident like this on who is to be in charge and duties of who is to do what. We should always ensure our safety as the responders regardless of the situation.

We managed to save a lot of lives but very much risked our lives. I really hope everybody and agency involved learned from it and be prepared for anything that is to come. I learnt a lot from the incident and hope to be more prepared in future. After all, I thank God for the lives saved in that day full of terror.

 

#CRIMEFRIDAY – HERE OTHER STORIES:

• Angry ebola affected community refused Red Cross treatment – Ambulance risked to be burnt
• The patient is the bad guy – An ambulance dispatch for a double stabbing
• Kasubi Tombs fire outbreak – When crowd goes wild against EMS teams