Hostage crisis in the Philippines – How difficult is the approach for emergency physicians?
Cases of hostage are very difficult to manage for ambulance crews. Physicians must face unsafe areas and assist in brutal murders, sometimes. This was the case of an EMT in the Philippines.
“THE CASE – Around 9:00 A.M of August 23, 2010, we received a call from 117 that there was an alleged hostage-taking. The Communication centre of my chapter referred the call to me since they do not know what to do. I ask questions to the 117 but they cannot give concrete picture of the situation. I relayed it to our chapter administrator and I was asked to mobilize our team to proceed since it was near our office.
I was currently the Chapter Service Representative of Manila who was handling the ambulance. In the case of the situation, I was the only trained personnel in our Chapter to respond in a conflict situation so our chapter administrator decided that I should go together with the team since I have the expertise. The composition of my team was mostly new and do not have experience in such incident since I do have a background and while we are not yet on the scene I already oriented them on the possible situation that we may have any other information that I already knew about the event.
As a Chapter Service Representative within my area of jurisdiction, I already know most of the personnel from other ambulances because some of them are my previous volunteers who were hired in other organization and most of the volunteer group recognized us for being the first in the scene. When we came to the scene initially the report was a hostage-taking of tourist we did not know what kind of ammunition that was being carried.
Communications in the field was challenging because the bus was in the centre of the Grandstand that the command post was on the other side, we only rely on the radio communication from the headquarters because back then we communicate only from the information of the National headquarters team from the ERU on the possible movement of the ambulance team.
We arrived in the scene and coordinated with the police station since there was a police station near where we had parked. Initial information that we had is there is one hostage taker “Senior Inspector Rolando Mendoza”.
Senior Inspector Rolando Mendoza with 31 years in service was summarily dismissed by Manila Police District due to involvement extortion incident in the Manila Police District. Mr. Mendoza bored the bus from Fort Santiago, Intramuros Manila on a tourist bus, Hong Thai Travel Bus, as what we have heard was carrying M16, Hand Gun and grenade. There was still some commotion if Mr Mendoza had placed a bomb on the bus.
At that point, we moved our ambulance from the side of the police station that has direct visualization from the bus and placed it at the back of the fire truck and not directly on site of the bus.
The primarily involved in the hostage crisis was a tourist bus composed of 22 people from Hong Kong and 3 Filipino riding the bus in the morning the hostage take released 6 tourists and 3 Filipino from the bus before he escalates the situation at 3 P.M. with his demand to reinstate to the service with all benefits and privileges. The people release are mostly children and the elderly.
The tension in the morning was not as aggressive when the actual tactical rescue was done by the Police since there were fewer people involved at the morning the people there were only a few media, ambulance provider and bystanders. Since the media regularly update the situation using the television there are many curious bystanders, politicians, media and others involved in the situation. Especially the family members of the perpetrator, one of the relative tried to get near the bus with a gun together with him and was intercepted actually after he was near the bus. He passes by our team not knowing that he has a gun and later was detained in the police station.
At night time we already knew that there would be an ultimatum from the perpetrator that later was moved but the government have its own ultimatum that they wanted the situation to be neutralized. Around 6 in the evening the family members of the perpetrator came to the police station near us and were demanding to talk to their father but were not permitted to go in the area and later made the trigger of the escalation of the situation to raise. In the hostage-taking, most of our personnel was scared of the loose bullets that may hit us and the possible explosion of the bus that we will be the collateral damage. The brother of Mr Mendoza at that time was restrained by the police because he was being uncooperative and trying to get the attention of Mr Mendoza to fight what he believes and do what has to be done.
In the situation that the police are trying to restrain the family members we already have background on what would be next that would happen I was contemplating at that time if we will get the relative a place him to the ambulance to lessen the tension from the family members and the police but since my team and I felt that we might be in the middle of a conflict we went back to our ambulance.
Mr Mendoza kept his communication with the media and became revengeful of the situation because he is seeing his family member suffered as the police are trying to arrest him. He started shooting at the hostages while SWAT, on the other hand, tried to hammer down the bus to get Mr Mendoza but he was killed and 6 survived the situation but 9 was dead. A few minutes later it was the most memorable and scariest moment that we felt since now we know that victims are being killed but we cannot do anything unless the police declared that the scene was safe and they were shouting all are dead in the bus.
In our organization, we have one ambulance that we think have the capacity to go inside the secured area that the task of that ambulance is to take the victims from the bus to our staging area on the opposite side but I was very different in what happened. I was assigned as the staging officer for the ambulances initially to organize the ambulance on the movements but it was changed by the police when they released the yellow cordon that we are now allowed to get inside the danger area. When we approached the bus the initial action was to bring down all the victims and tried to bring them to the hospitals near the situation.
It became harder for us since it was raining while we are getting the victims out of the bus and trying to place them to different stretchers. I felt less prepared or caught me off guard when it rained since we have less visualization of the area and all the blood from the victim was falling together with the rain to my face. I was a very concern with my skin that there should no abrasion during the event since I do not know the history of the people that I am facing and all the victims are being seen by me. In that incident, the organization felt high in moral since we have catered the situation better than the government. Our social service even was even thanked by the victims and the relatives before leaving the country.
ANALYSIS – In the situation, because we have more ambulance and contingency in the area we had planned our actions already on what to do but there are still some politically inclined organizations that wanted to be working alone. Most of the ambulances present was already aligned on the situation that we have and all ideas were already provided on what to do but as we know sometimes plans are not going to work depending on the situation.
One of the dilemmas that I needed to decide on was bringing inside all the ambulances in the danger area since there was a police officer that was screaming at us that the situation is already safe and he put the yellow cordon down already. Which made me think at that time if there is a possible bomb on the bus that I would be liable to all the volunteers involved.
In the actual scenario based on my experience was the Standard Operating Procedure since that time we apply our experiences, not from the SOP. When ambulances from different chapters were arriving and media is promoting the situation most of my volunteers wants to be deployed in the ambulance and wanted to add the reserve ambulance that we have in the chapter but I did not deploy the ambulance since we know that there was a bomb in the bus. So I decided not to deploy the ambulance because that time all of the national capital regions ambulance was deployed and if that would happen there would be no ambulance to transport the volunteers involved in the situation.
Communication with the ambulances and the organization was frequent even for the food we were being given up to date for food allocation, water and other needs in the field at that time.
Even the situational update was being given to us but in a limited scope since even the tactical strategy was being heard. After we have brought all the victims to the hospital after 10 hours all of the ambulances was recalled to the national headquarters after scaling down the situation.
We were debriefed by the management but as a group, since it was late at night and our ambulance suddenly had some trouble we went back to our chapter to have our peer psychosocial support in a smaller group. We ask one of my volunteer who has a training of psychosocial support from our welfare service to facilitate our peer debriefing. After that, we had a little dinner before going back to our houses and most of us were picked up by relatives. The training provided to me at that time with the first aid in armed conflict and the exposure in a different situation made me adaptive to the situation.”