EVACUEES. Soldiers escort rescued civilians at a village on the outskirts of Marawi on May 31, 2017. Photo by Ted Aljibe/AFP

MANILA, Philippines – Local terrorists occupying Marawi City in Lanao del Sur have forced nearly 400,000 people in the wider area to flee their homes, officials said on Saturday, July 1, while warning of disease outbreaks and psychological trauma among refugees.

The city of Marawi, considered the Muslim capital of the largely Catholic Philippines, has been reduced to a ghost town after self-styled followers of the Islamic State (ISIS) movement launched an assault on the city on May 23.

For more than a month, the government has deployed jet fighters, attack helicopters and armored vehicles to crush the militants who are members of the so-called Maute group. (IN PHOTOS: Death and destruction in Banggolo, heart of Marawi)

The fighting has left over 400 people dead, while the Maute members still control parts of the city, using snipers and improvised explosive devices to slow the military's advance. (READ: Marawi death toll: 82 gov't troops killed, 39 civilians slain)

Liza Mazo, the regional civil defense director, said it was not just the city's residents leaving the area but also people living in the surrounding communities.

Out of 389,300 who have fled, over 70,380 people have been housed in 79 government-run evacuation centers, while the rest have sheltered with their relatives, according to social welfare department figures. (READ: Marawi children need our help)

Mazo said that relief officials have struggled to deal with outbreaks of illness at the evacuation centers as government forces continue to launch air strikes and artillery barrages against the militants.

"There are alarming cases of skin diseases and gastroenteritis. We want to control the outbreak, not just in the evacuation center but even the home-based (refugees)," she said.

"There are also cases of psychological trauma from the fighting," she added.

Some 26 people who have fled Marawi have since died in hospitals from various ailments, according to the health department's local spokesman Jun Galban, but he declined to say whether their deaths were related to the evacuation.

President Rodrigo Duterte, who declared martial law over Mindanao to deal with the crisis, vowed on Saturday that government forces would crush the extremists.

"We will not go out there (Marawi) until the last terrorist is executed," he said in a speech at the 50th founding anniversary of Davao del Norte.

At one point in his speech, to demonstrate his seriousness, he lifted his shirt to reveal a holstered pistol.

But he conceded, "we are having a hard time."

"We never realized the magnitude of their preparation for their explosives. We got there, they were positioned (with) their snipers. We practically had to climb upward," he said. – Rappler.com</s>Islamist terrorists occupying a southern Philippine city have forced nearly 400,000 people in the wider area to flee their homes, officials said as they warned of disease outbreaks and psychological trauma among refugees.

The city of Marawi, considered the Muslim capital of the largely Catholic Philippines, has been reduced to a ghost town after self-styled followers of the Islamic State movement launched an assault on the city on May 23.

For more than a month, the government has deployed jet fighters, attack helicopters and armored vehicles to crush the militants who are members of the so-called Maute group.

The fighting has left over 400 people dead, while the Maute fighters still control parts of the city, using snipers and improvised explosive devices to slow the military’s advance.

Out of 389,300 who have fled, over 70,380 people have been housed in 79 government-run evacuation centers, while the rest have sheltered with their relatives, according to social welfare department figures.

Liza Mazo that relief officials have struggled to deal with outbreaks of illness at the evacuation centers as government forces continue to launch air strikes and artillery barrages against the militants.

“There are alarming cases of skin diseases and gastroenteritis. We want to control the outbreak, not just in the evacuation center but even the home-based (refugees),” she said.

“There are also cases of psychological trauma from the fighting.”

Some 26 people who have fled Marawi have since died in hospitals from various ailments, according to the health department’s local spokesman Jun Galban, but he declined to say whether their deaths were related to the evacuation.

President Rodrigo Duterte, who declared martial law over the southern Philippines to deal with the crisis, vowed on Saturday that government forces would crush the extremists.

“We will not go out there (Marawi) until the last terrorist is executed,” he said in a speech to government workers.

But he conceded, “we are having a hard time.”

“We never realized the magnitude of their preparation for their explosives. We got there, they were positioned (with) their snipers. We practically had to climb upward,” he said.</s>"We are all trained to triage patients and evaluate them systematically. Level of consciousness, air way, breathing, circulation, and then based off those situations we take car of them," says Nathan Kragh, Registered Nurse at Northwest Texas Healhcare.

AMARILLO, TX (KFDA) - When working in the Emergency Room quick decision making could mean the difference of life or death, but our nurses and surgeons here in the panhandle are trained to handle any situation.

The nurses and surgeons who see patients with significant trauma's have minutes to come up with a plan and head to the OR because with trauma patients timing is everything.

Northwest Texas Hospital is a level three trauma center, meaning they can see all types of traumas ranging from a stubbed toe to a major accident. But, not all traumas they encounter are treated the same. They work quickly using state of the art equipment to determine quickly their plan of action.

After trauma patients enter the emergency room nurses and doctors have to quickly determine their course of action to save that persons life. Depending on the injury, doctors have a very limited window to diagnose and treat a patient and get them to the operating room as quickly as possible.

To diagnose they use what is called the golden hour of trauma. First they triage, meaning the doctors or nurses determine the urgency and severity of your wounds or illness. Then they work within the first hour to stop the bleeding, maintain your body temperature, and use new state of the art machines to determine if you have internal damage. Using these machines and their quick decision making ability has and will save lives.

Nathan Kragh an RN at Northwest says "We are all trained to triage patients and evaluate them systematically. Level of consciousness, air way, breathing, circulation, and then based off those situations we take car of them."

The nurses are working continuously to keep up with their skills and licensing to make sure you are receiving the best care possible. When asked how often they are learning new skills and techniques they answered almost every week. The latest technique is learning the new ways to stop the bleed. The leading cause of death in a trauma is blood loss and stopping someone from bleeding can help to save their life.

Getting a patient from the ER to the OR as quickly as possible will save a life. Being a trauma surgeon in the OR is a completely different game. Unlike other types of surgery you have no time to prepare for what is ahead.

Like all other surgeons they rely on other people to help them get into surgery successfully. They rely on the sterilization room to not only keep the tools clean and ready when the doctors need them. The surgeons also rely heavily on their nurses. They know what supplies they need and where to get them and as an OR nurse you use different tools, and need to know more about all the supplies to help the doctors be successful in surgery. For trauma surgeons this reliance is extra important, they are unsure what they will need to perform and sometimes you can't know the extent of the damage until you are already in the surgery.

Dr. Haris Nazim a trauma surgeon says, "The big basic principles of surgery are the same but what makes it different is first the high intensity nature. A lot more life threatening injuries, that you need to address. And plus from a surgical stand point you need to make decisions in seconds other surgeons do have more planning."

It is important that a trauma nurse makes sure they diagnose the patient as quickly as possible to help the surgeons make a tentative plan of action. They work to get the patent to the OR as quickly as possible. Being a trauma nurse is a stressful job, but our nurses here in the panhandle are ready to handle any situation and will work to save your life.
More than 400,000 people displaced by the conflict are affected by disease outbreaks and psychological trauma.