12 October 2023 was the 45th anniversary of the Spyros disaster.
Left clueless by this statement? You are not alone. Many doctors have not heard about this event; some were not even born then.
The Spyros incident was the worst postwar civilian disaster in Singapore and it remains our worst ever industrial accident. Recalling the event, thinking about how doctors lived up to the challenge back then, reflecting on the lessons learnt and speculating how present-day doctors might cope should a similar event occur today offer much food for thought.
The events
What actually occurred? On 12 October 1978, the Greek oil tanker, ST Spyros, exploded while it was being repaired at Jurong Shipyard. The cause of the explosion was inappropriate hot work, and "[t]he blast was so immense that it flung debris 100 metres away with a large chunk landing on another ship Trade Fortitude injuring two people on board".1 At that time, around 150 people were returning to work on the Spyros after their lunch break. 145 of them became casualties, of which 76 died and 69 survived.2 The clinical and medical response, mainly from the Singapore General Hospital (SGH), are well documented by Prof Lee Seng Teik, the deputy head of the Burns Unit at that time.3 The SGH Department of Pathology also played a crucial role, both during the medical response and later in forensic pathology during the subsequent investigation, and their efforts are also preserved as an oral history account by Prof Chao Tzee Cheng.4
Snapshots recalled
My pre-clinical class bore witness to this drama. Many of us saw things we would not forget for the rest of our lives. These images remain like snapshots, posters pasted in our minds, advertising movies long past.
Heading from King Edward VII Hall to the hospital blocks, I saw people starting to gather outside two locations in particular: Norris Block, where the Burns Unit was then located, and the A&E department, where people sought whatever shade from the afternoon sun they could find. Without even needing a toot of the horn, they would swifty part as another ambulance, or more likely a lorry, drew up to unload its casualties right at the Burns Unit's doors. Within hours, these would swell to significant crowds of stunned relatives, standing in silence that was occasionally punctuated by outbreaks of quiet sobbing. A third, smaller group started to form pointlessly outside the old mortuary.
Indoors, I recall medical students helping to clerk details and set drips, especially in the "overflow wards". Doctors, nurses, porters and other staff from unrelated departments also volunteered at the Burns Unit to see how they could help. I recall a few pre-clinical students squatting or sitting by the stretchers of the very severely hurt, keeping them company so that they would not have to die alone. Of the 76 casualties who were brought to SGH, seven died within 24 hours and another 12 perished over the next ten days.1
And I would for decades remember the smells of oil, diesel fumes and burnt flesh to be pungent and falsely familiar. My class representative, Prof Christopher Cheng, remembers most the moaning of dying men. Dr Hweena Ng recalls it being chaotic and that some victims had faces so swollen from the burns that they could not open their eyes. These vivid memories stayed with her through life. Dr Ng Chin Lin, one of five plastic surgeons tending to the victims in the Burns Unit, recalls seeing people so badly injured that it was difficult to assess their injuries, with their faces all black so that they were unrecognisable and their bodies covered with thick, black oil.1 Prof Lee ST himself recalls how the doctors and nurses of the Burns Unit worked "solidly for three days with no time even to have a shower".1 Thanks in large part to their skill and dedication, 57 of the casualties survived.
Better prepared for the next mass disaster
In the chapter on the Spyros incident in More than Skin Deep, Prof Lee ST bluntly states: "... Singapore must always be prepared for a mass disaster on the scale of Spyros. Some 80% of Singapore's population live in high-rise buildings and we must be aware the prospect of a 'towering inferno' is ever present. Besides, Singapore has one of the busiest airports and ports in the world plus it is home to oil refineries and petrochemical plants. A mass disaster can happen at any time... and how we respond must remain foremost in our minds."1
The truth is that mass disasters can happen even in developed countries, even to this day. The 2009 Hudson River plane crash off Manhattan, US; the 2011 earthquake and tsunami in Fukushima, Japan; the 2017 Grenfell Tower fire in London, UK; and the 2020 Beirut port explosion in Lebanon. These are all events that remind us that Prof Lee is correct.
In the 45 years since the Spyros incident, how has Singapore's medical response capability changed? There are many more well-trained staff, doctors and nurses alike at both the specialty and subspecialty levels. The infrastructure has improved tremendously – SGH has been rebuilt, and the Burns Unit is now recognised as the "Burns Centre to the Region".1 Regional hospitals have been built, each with some of the old 1978 SGH's capabilities, and every one of them certainly better placed to help than the Alexandra Hospital was back then. Readiness is also regularly tested. In the larger local public hospitals, large-scale mass casualty exercises are conducted every few years.
Are our younger colleagues "tough enough", whether mentally or physically, to cope with the stress of the next mass disaster? I am confident that when called to help in the"next Spyros incident", they will step forward to fill the breach, bringing their individual skills and youthful positivity. They will make the difference, just as their senior colleagues did 45 years ago. Modern infrastructure lays a strong foundation, allowing the professionalism of our doctors to save more lives.
Everyone helping in any way they knew how