Between 4:00 pm on January 28, 2011 and 2:00 am on January 29, health workers at Cairo University Hospital had to break open locked storage areas to get more operating supplies and rely on volunteer surgeons who rushed in from the protests.

Communication services in the area of Tahrir Square, including cell phones and the Internet, were almost completely shut down during that wave of regime violence against protesters, researchers said.

Still, most patients treated at the facility survived their injuries.

"We believe that forming multidisciplinary teams of surgeons, anesthesiologists and nurses was the key to our effective management of such a huge event," researchers led by Dr. Mohamed Sarhan of Cairo University Hospital reported in the Annals of Surgery.

During that night, they said, those teams examined patients, determined the severity of their injuries and worked with specialists to prioritize and expedite treatment.

The majority of critical patients needed surgery within six hours of arrival at the hospital, most commonly with head and neck injuries, followed by arm or leg and stomach trauma.

Forty of a total 453 patients who came in needing immediate care that night or over the following week were dead on arrival or died shortly after being admitted. Fourteen of them were killed by gunshots to the head.

According to some estimates, a total of more than 6,000 people were injured and over 800 killed during the protests against then-Egyptian president Hosni Mubarak.

Due to the possibility of future communication blackouts during such emergencies, Sarhan and his colleagues said all hospital workers should know where to go and what teams of general doctors, nurses and surgeons to form in the case of such events.

"Communications are always a problem in disaster settings," said Dr. David Shatz, a trauma surgeon from the University of California, Davis Medical Center in Sacramento who wasn't involved in the new research.

"Cell towers go down, they get overrun," he said.

Shatz told Reuters Health that since the World Trade Center attacks on September 11, 2001, U.S. hospitals have focused on installing instant command systems that allow for fast triage of patients.

"Most hospitals are pretty darn prepared," he said. "I think most places have a good plan."

Still, Shatz said, there's only so much hospitals can do to anticipate future emergencies - and he thought Cairo University Hospital did an "impressive job" given the number and severity of injuries it faced.

"Every single event is different," he said.

SOURCE: bit.ly/OltDZN Annals of Surgery, online August 22, 2012.

• A Permanent Economic Emergency