SINGAPORE - It was nearly the end of a shift at 10pm at Tan Tock Seng Hospital’s (TTSH) emergency department on Dec 8, 2013, when Dr Phua Dong Haur noticed something unusual.

Several ambulances had arrived simultaneously at the drop-off point, and the paramedics looked especially flustered.

The ambulances were bringing in dozens of casualties, but these injured people were uniformed police and Singapore Civil Defence Force (SCDF) officers.

Most of them were in shock, recalled Dr Phua, 50, who was one of two consultants on duty that night.

Initially, Dr Phua did not register this, as the ones who usually escorted disturbed patients and the wounded to hospitals were lying on stretchers.

The ambulance crew told him there was some unrest around Serangoon Road and more casualties were expected.

In total, 62 people – 37 police officers, 12 SCDF officers, five private security officers from Certis and eight members of the public – were injured in the riot.

TTSH’s emergency department would treat 36 of them until the following afternoon. These were mainly male police and SCDF officers.

The shell-shocked faces of the men in blue remain vivid in Dr Phua’s mind.

Dr Phua, who is a senior consultant in the department, said: “Seeing uniformed officers protecting us brought into the emergency department for help and treatment hit me and made me realise these officers are also human.”

It had been a busy afternoon at the emergency department, and the staff were preparing to go home after their eight-hour shift.

Then, they got word about a possible surge in patients. The team of about 30 clinical staff swung into action.

The other consultant on duty that night, Dr Eric Wong, 46, recounted how they split into two groups: one for incident response and the other to continue caring for the regular patients.

They designated an outdoor area to receive patients from the riot. Staff arranged chairs for those with minor injuries to rest, and prepared trolley beds for those more seriously hurt.

They also made space in resuscitation rooms, in case some had life-threatening injuries.

Then, the patients streamed in.

One was a foreign worker with a gaping wound in his thigh.

Dr Wong, who treated him, said: “His jeans were soaked with blood, and he was agitated and in pain.

“It took some time to break the language barrier between us through hand gesturing and broken English, to convince him that I only wanted to help.”

After having his wound dressed, the man thanked Dr Wong for caring for him.

A 2015 research paper published in the Singapore Medical Journal on the experience of TTSH’s emergency department during the riot noted that most of the casualties suffered head and limb injuries, abrasions and bruises.

Other injuries included smoke inhalation and a finger fracture, said the paper, co-authored by Dr Phua, Dr Wong, their colleagues and Dr Ng Yih Yng, a former SCDF chief medical officer who is now a senior consultant in TTSH.

All patients were treated and discharged as outpatients, except for one person who was admitted for a head injury.

The riot also threw up an unexpected complication, said Dr Phua.

Some of the injured officers were armed, which could have posed a danger to hospital staff and patients.

The doctors notified the police, who came to remove the weapons.

Dr Phua said it was a chaotic situation, but hospital staff knew their roles and did not panic.

The outgoing team voluntarily stayed back and worked extra hours until the situation could be managed, and the incoming team stepped up quickly.

The two doctors, who were the most senior physicians in charge that night, went home only the next morning.

Said Dr Wong: “I was exhausted when I reached home early in the morning. I slept peacefully without dreaming.”

The research paper noted some lessons the emergency department learnt that night.

Usually, in such a situation, it would be the Ministry of Home Affairs declaring a civil emergency and the Ministry of Health activating emergency departments at hospitals.

But that night, due to the unprecedented nature of the riot, the paramedics were the first to alert the hospital.

The paper said emergency doctors should hence be open to information from unofficial sources, so they can better prepare their response to a possible mass casualty incident.

Also, TTSH did not activate its hospital-wide mass casualty incident plan that night, which would have allowed more staff to be deployed, though it could have done so given the number of casualties.

The decision was made to keep operations within the emergency department as the injuries were not as serious. The department had handled other incidents with multiple casualties and could cope with the surge in patients.

So, while emergency department staff must be familiar with their hospital’s mass casualty incident plan, they must also be flexible and adapt according to the nature of the incident, noted the paper.

Dr David Teng, a consultant based in TTSH’s emergency department, said that while the hospital handled the situation well, there is always room for improvement.

He said these learning points are integrated into the hospital’s response to civil emergencies, while staff continually draw lessons from other local and international situations.

In the last decade, TTSH has also invested in staff training and infrastructure to develop its response to all threats.

This includes an upgraded system that allows staff to access patients’ medical history and records across different institutions more seamlessly, and getting paramedics to share patients’ injuries and vital signs with the emergency department in real time on the way to the hospital.

For Dr Phua, the riot made him appreciate police and SCDF officers more.

He said: “(The Little India riot) made me more appreciative of them putting themselves out there to keep us safe.”

Dr Wong, who is now group chief data and strategy officer at the National Healthcare Group, still practises part-time as a senior consultant at TTSH’s emergency department.

He said: “(The riot) has reaffirmed why I chose this speciality in the first place. I want to be there to help when it matters most.”