The day Darwin woke after Bali nightmare
FIFTEEN years ago, a bomb blast tore through Bali’s Sari nightclub, causing unprecedented human carnage. Fortunately, a dedicated team in Darwin rallied together to save more lives than thought possible, as HAYLEY SORENSEN writes
ONa Saturday night 15 years ago, just after 11pm at Bali’s famous Kuta entertainment precinct, a noise rang out above the normal nightclub din.
It was the sound of a bomb, detonated inside the backpack of a suicide bomber in the packed Paddy’s Bar.
Less than a minute later, as people poured out into the street looking for safety, a Mitsubishi van parked outside the Sari nightclub exploded.
The eventual death toll from the Bali bombings was 202, 88 of whom were Australians.
More were injured. For many of those wounded Australians, and a handful of internationals, Darwin was the first port of call. ROYAL Darwin Hospital’s newly appointed director of anaesthetics Brian Spain was driving to a conference at the Mirambeena Resort on Sunday, October 13, 2002, when he first heard news something had happened overnight in Bali. Exactly what wasn’t yet clear.
Dr Spain recalled being irritated by one of his anaesthetist colleagues at that conference.
The colleague, a high ranking army reservist, kept ducking out to answer her phone throughout the morning. At the morning tea break, what she was doing on the phone calls became apparent — she was helping to organise the repatriation of Australians injured in the attack.
As the closest Australian tertiary hospital, RDH would be the receiving point.
“We all went straight from the conference to the hospital where everyone was preparing. What for, we didn’t really know at that stage,” Dr Spain said.
“We knew it was bad — and we knew it involved a lot of people — but we didn’t really know how many or how severely injured they would be.” IT took 26 hours from the time the bomb went off outside the Sari Club for the first casualties to touch down on the tarmac in Darwin.
A couple of Top End-based reservists had flown to Bali to help triage the patients and determine who would be first to be evacuated to RDH.
During the lull, the hospital prepared. Phone trees were activated to notify hundreds of staff of the impending arrivals. Extra burns equipment and medication was found.
Now-retired burns nurse Alison Mustapha ran impromptu refresher courses in burns management, and two specialist burns surgeons were flown up from Adelaide.
By about 6pm on that Sunday, with another eight hours before the first evacuees would arrive, a 48-bed receiving ward had been set up.
Dr Spain recalled a tense atmosphere in those hours.
“There was a sense of foreboding and a sense of dread; we didn’t know what was coming but we knew we would see horrifically injured people,” he said.
There were 12 ambulances waiting at the airport to meet the first Hercules aircraft carrying patients into Darwin. They had been pulled from all across the Top End to shuttle the severely injured patients — some with burns to almost their entire bodies — to the hospital in Tiwi.
When the back door of the aircraft opened, it was “the most incredible sight”, Dr Spain said.
People were stacked three high, lying on military medical
stretchers. There were 22 severely injured patients on that first flight, many critical.
Dr Spain led the handover team at the airport.
As patients were transferred into the ambulances, doctors and nurses climbed in with them to perform lifesaving support on the way back to the hospital.
The operation was repeated twice more, bringing a total of 75 patients to Darwin. FOR a period of 36 hours, RDH and its staff were stretched further than anyone would have believed possible.
In 2002, RDH was capable of dealing with patients with burns to 25 per cent of their bodies. Many of the 48 who were eventually evacuated to interstate burns units had sustained injuries far greater. And then there were the traumatic injuries — the impalements, the amputations, the pressure wave injuries to ears and bowels.
Only one of the evacuees died while at RDH, a survival rate far greater than could have been expected.
Len Notaras was the hospital’s general manager at the time.
“You look at RDH today, and it’s up there with the major tertiary hospitals; it has nine operating rooms,” Professor Notaras said.
“But we did all of this with an emergency department that had two resuscitation areas. On paper it looked impossible. In reality it was phenomenal, and it wasn’t machines, it was about people.”
It was a collective effort punctuated by stories of individual achievements.
Prof Notaras recalled the story of one patient wheeled into intensive care.
“A very scary senior operating nurse came out and demanded a handover from this fellow pushing the trolley. He looked at the patient and looked at the nurse and told her he was the gardener,” he said.
“It’s not that we were overwhelmed, but that we had a superb disaster response in place and everyone did what they needed to do.
“To this day, it’s still a textbook example of how to respond to a disaster.” IN 2004, Professor Notaras received a phone call from then-prime minister John Howard.
During the crisis, Prof Notaras had liaised with a clutch of high ranking politicians and public servants — including Howard — to coordinate the response.
This phone call was about preparing for the future — what could Australia do to make sure it was best placed to deal with similar events?
Between them, they came up with the concept for the National Critical Care and Trauma Response Centre.
It would be a world leader in disaster management and training, with specialists ready to deploy at short notice to theatres of disasters — both man-made and natural — at short notice.
Less than a year after that facility was announced, the second Bali bombing occurred.
Comparatively, the second bombing was minor — about 28 people were evacuated to Darwin.
It justified the need for the centre, and since 2005 NCCTRC doctors, nurses and staff have responded to the 2009 Ashmore Reef disaster, when a boat carrying asylum seekers exploded off the coast of WA, to Typhoon Haiyan in 2013, the 2010 Pakistan floods and the assassination attempts on Jose Ramos Horta and Xanana Gusmao.
Prof Notaras is now the centre’s executive director.
“The upshot of a dark side of a tragic history has been a bright side of innovation and vigilance,” he said.
“We’re part of an international community that is prepared. We may only have 34 full time staff, but we have a virtual repository of almost 800 individuals.”
Prof Notaras was in New York this week on the day of the Bali bombing’s 15th anniversary.
Thousands of kilometres apart, the two places are bonded by tragic acts of terrorism. Prof Notaras said New York reminded him of the inevitability of another disaster. Bali is bracing for a volcanic eruption and acts of terror are splashed across news bulletins every week.
In addition to his assortment of medical and management degrees, Prof Notaras has degrees in history. “There’s nothing new in history,” he said.
“Something will happen again. The more prepared we are and the more vigilant and the more quick we are to respond, the more lives and limbs we will save.” THERE’S a little club of Bali bombing veterans still working at RDH. For them, it’s hard to believe it has been 15 years since that Hercules jet touched down at Darwin airport carrying its first cargo of patients, some of whom were so badly burnt identification was tough.
Dr Spain is still the director of anaesthetics, though he’s no longer newly appointed.
He said there was still a strong sense of camaraderie among the staff who received patients that night.
Even for battleworn Darwin doctors, who spend every day stitching together patients who’ve encountered their own personal disasters of domestic violence, booze, drugs or road crashes, the carnage wreaked in Bali is difficult to fathom.
“We know even now, people still have pretty frightening memories that occur years later. It was a harrowing event for the staff as well as the victims,” Dr Spain said.
But, a decade and a half on, the pride outweighs the horror.
“The hospital infrastructure in those days was aged but we had great people. When you’ve got good people and good systems, you can do great things,” Dr Spain said.