The ‘Nord-Ost’ tragedy gradually fades away into insignificance, and now it seems as if it did not really happen at all in Moscow, and Lord knows how long ago it all was. Repairs to the Moscow bearing plant’s theatrical center are in full swing, and the show goes on. Everything is A-OK!

Meanwhile, many mysteries about the tragedy still remain out of the public eye. One of these mysteries is the main reason as to why there were so many deaths: 129 people.

During the first days after the tragedy, the media discussed the topic in every way possible. They fingered various types of gases, and sprinkled terms about, but even back then many experts drew attention to the fact that someone was specifically leading the public away from the true causes of peoples’ deaths. Every now and then another exotic theory would pop up in the pro-Kremlin media, or among the ‘loyalist’ journalists. One such theory was that the hostages died of “acute depletion and as a result of metabolic imbalances.” Another was that people died from “an allergic reaction caused by the mixing of the gas with ammonia vapors in the supersaturated atmosphere of the auditorium,” while yet another theory was that they simply “had not worked out the right dosage.” If readers and viewers were to look closely at these theories, and examine them, they might start believing that there were only external factors that led to the deaths of 129 hostages, or in other words: fate. It is simply how everything worked out, s--- happens and all. We sure wished it could have turned out better, but that is the way things go. Sorry. But look how many we did save!

There are participants in these events, however, that do not share the position of the semiofficial media.

I managed to chat with one of the intensive care physicians on duty in an ICU that received hostages. His story turns out to be very different from what I had heard earlier.

My source’s name is Yuri. Not very long ago, he was an ICU medic at one of the frontline hospitals in the North Caucasus. He went on seven missions to Chechnya, but poverty and a lack of housing forced him to resign and return to his parents’ modest home in Moscow. Now Yuri works at one of the city hospitals. It was his hospital that received large numbers of injured hostages after the assault.

Yuri, why did this gas have such different effects on people? Some ran out of hall on their own, while others had to be carried out. Some ended up in intensive care with diagnoses of severe poisoning, while others were ready go home that same day. Why?

“Let me correct you right away: nobody in our hospital had a diagnosis of severe poisoning. I repeat, nobody! The gas was secondary. If the cause had been the gas, then there would have been something systematic about the mortality, something in common. They would, for the most part, have been heart patients or asthmatics or children or the elderly, or even red-haired people, for example. But none of the dead could be categorized, without exception. There were both the young and the old, the sick and the healthy killed. Anyone! And the survivors included asthmatics and people who’d suffered heart attacks, and even some people who’d recently suffered a stroke. So, if the gas itself did cause death, in my opinion it did so in only a few cases. Out of the more than eighty admissions we had, we observed only four or five with any signs of poisoning. All the rest came to us with quite a different diagnoses.”

What were those?

“Asphyxia. Cessation of respiratory function, and, as a result, disruption of the normal blood supply to the brain.”

But was this not a result of the gas?

“Not quite. Here we must understand a certain detail. Certainly, use of the gas caused many people to be in a state of suffocation, with vomiting, reflexive respiratory arrest, and loss of consciousness, but this is a primary reaction that can be easily be reversed with timely first aid. When the people affected by the gas started to arriving at the hospitals in the very same condition they were in when they carried out of the auditorium, some even thirty or forty minutes after the onset of respiratory arrest, in such cases even the most talented doctor is often powerless.”

Do you mean to say that the main cause of death is that they did not receive timely medical assistance?

“Exactly! Dozens of patients were brought in on ordinary metro buses that were sent out only after they were full, and the whole time they were parked there, affected people were inside without the medical care they needed. Everyone remembers the news footage, where you could see unconscious people through the windows of the buses, lying about in various positions. We call these buses ‘corpse-mobiles’. Right away they’d carry a dozen and a half dead bodies out of each of these buses. Only a few times were hostages brought in on ambulances, and almost all those people made it.”

“I remember. I was just shocked that these PAZ buses brought in dozens, just piled on top of each other. Those who were on the bottom, underneath this heap, they didn’t require any assistance. They were simply crushed. At the very bottom there was a 13-year-old girl*. Dead…

But why did this happen? Was it really impossible to save all these people?

“Of course, it was possible! And it should’ve been done! We’re required to save them!”

But how? All around it was just one big mess, and there was the danger of an explosion, and shooting going on. How could it have been possible under such circumstances to save these poisoned people?

“Don’t exaggerate. There was not any confusion in particular. ‘Alfa’ worked flawlessly. Already a quarter of an hour after the start of operation, all the militants were dead and the evacuation of the hostages began. They just needed to get something organized, and this is something that every doctor learns in classes for field military medicine.”

And what should have been done?

“Almost a hundred and fifty years ago, the great Russian physician Nikolai Pirogov, the founder of field surgery, wrote the book on medical response during a mass casualty event, and this is the concept of sorting (triage) and first aid. 90 percent of a wounded patient’s survival depends on the quality of these activities. Right by the theatrical center they should’ve deployed an evac center, where several ICU teams could provide first aid prior to evacuation.”

I saw them giving some kind of injections to unconscious people lying there, and slapping them on their cheeks…

“That's not first aid, and it was being provided by run of the mill rescue workers and soldiers. Yeah, they injected them with ‘antidote’, but what’s the use if a person’s choking on his vomiting or his breathing reflex has simply stopped? No use at all. After fifteen or twenty minutes, that person is dead.

“The first thing they needed to do was sort the injured. Those who felt okay could immediately be put on buses and delivered to hospitals, but those who were unconscious, especially who weren’t breathing or didn’t have any other signs of life, they needed to receive qualified first aid, on the spot.

“The algorithm was developed decades ago, and every ambulance medic and military field surgeon knows it like the ABCs.

“First, ensure breathing. Clear, if necessary, the mouth of foreign objects, if necessary intubate, insert a tube to provide an airway, and try to restore spontaneous breathing. If this is not possible, perform artificial respiration and heart massage.

“Secondly, stop the bleeding, if necessary.

“Then treat for pain.

“Even these elementary actions would be enough to save most of the victims.”

But then who is to blame? Who was supposed to do this work?

“Do you want to know my opinion? I’ll tell you: the Minister of Health, Shevchenko. Some time before the attack, he was warned that gas would be used. All hospitals in advance got the order to prepare for mass casualties. That there was going to be an assault, Shevchenko, of course, knew in advance. All the more so, without the approval of the health minister, it is unlikely that anyone would even have dared to use the gas.

“Shevchenko’s education is as a military doctor. For many years he taught at the Military Medical Academy, and has a high-ranking military and scientific title. He, if anybody, had to understand the effects of chemical agents and the ‘techniques’ of care under these conditions. These are basic things, but nothing essential was even organized. Everything was tossed onto the shoulders of the city government and metropolitan ambulance service. As a result, confusion began and the most important thing in saving people was lost: time! During the Soviet days, such omissions were called criminal negligence. People ended up in jail — even people with large epaulets. Everything is different nowadays, and, of course, nobody asks Shevchenko. He’s a fellow Peterburger, and a personal friend of the president. Sobchak was patron for both of them. Remember they took got him to Paris. Back then they had ‘skill’ and ‘operational efficacy’ to spare…

So it turned out like the story with the Kursk. People died because of the blatant  incompetence and carelessness of the senior leadership, that once again decided to work act at random, slipshod, is that not so?

“You know, I specifically went to several autopsies of victims, and I can say for certain that had these people been provided timely and correct medical assistance, they would have remained alive. Consider that my answer.”

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