'Deep sadness': Doctors, nurses recall intensity of treating victims from River Valley fire

CNA

11-05-2025

SINGAPORE: Just a few hours into her shift on the morning of Apr 8, nurse Lim Zi Ying at KK Women's and Children's Hospital (KKH) was pulled from her routine duties to respond to an emergency of unprecedented scale in her 21 years of service.
A shophouse along River Valley Road, just 1.8km from the hospital, had caught fire. Inside, multiple people – including children – were trapped.
Videos of the rescue, showing victims perched precariously on a narrow ledge on the second storey, quickly went viral and gripped the nation.
By late morning, 22 people – 16 children and six adults – had been transported to hospitals. Among them was a 10-year-old Australian girl who later died from her injuries.
KKH, located along Bukit Timah Road, and Singapore General Hospital (SGH) at Outram were among the hospitals that received casualties from the blaze.
EMERGENCY PROCESSES TRIGGERED
Ms Lim, a senior nurse clinician at KKH's Children's Emergency, steeled herself for what proved to be an intense few hours.
She and her team raced to prepare the resuscitation room in the emergency department, activating equipment and laying out medication.
Casualties from the blaze began arriving via ambulances at around 10.45am.
The hospitals cannot reveal the number of casualties they received or the extent of their injuries, but Associate Professor Sashikumar Ganapathy, the head of KKH's emergency medicine department, told CNA that casualties arrived in batches until past noon.
He described the logistical challenge of managing an unknown number of incoming casualties.
"But that is part of the training right? We are trained to be ready," said Assoc Prof Ganapathy, who is also deputy chairman of the hospital's medicine division.
It was his first time receiving paediatric casualties from a fire of such a scale, he said.
Over the next few hours, more than nine medical departments were activated, including ear, nose and throat specialists, paediatric anaesthetists and plastic surgeons.
Fire-related injuries can lead to severe inhalation trauma in children, making airway management a top priority. For children, it falls to the paediatric anaesthesia team to ensure that the respiratory tract functions normally and the patient's breathing is not obstructed.
Treatment included administering medication via face masks, inserting IV lines, managing pain and stabilising breathing.
As the leading nurse, Ms Lim also coordinated with senior management to ensure sufficient manpower and resource allocation, while supporting both staff and patients on the ground.
Despite it being her first time as the leading nurse in an incident of this scale, Ms Lim said she is grateful that everything went smoothly.
"My training in emergency nursing and also dealing with mass casualty incidents has allowed me to be able to stay calm and composed in this kind of situations," she added.
Among those called into action was Dr Gale Lim, head of the department of plastic, reconstructive and aesthetic surgery, who had experience managing mass casualties from a coffee shop gas explosion a decade ago.
When casualties from River Valley began arriving, the first thing she did was to organise and activate a team of about five doctors and up to eight nurses, who were split between the Children's Emergency and the ICU, where they saw to burn wounds.
She knew exactly what they had to do – "carefully and systematically assess" every patient.
Her team followed a careful process: removing temporary dressings, assessing and documenting each wound, before 'scrubbing down' – where a layer of the patient's dead skin is removed and the area cleaned up before it is dressed.
Doctors typically assess the percentage of total body surface area burns and the depth of burns, before coming up with a treatment plan. More serious wounds could require surgery such as skin grafting, where dead tissue is replaced with healthy skin from another part of the body.
PREPARING FOR THE UNKNOWN
At SGH, the arrival of paediatric patients – uncommon at the adult-focused hospital – required rapid adaptation.
Nurse clinician Muqtasidatum Mustaffa said the situation was complicated by not knowing how many patients to expect.
"There was a lot of uncertainty. We just had to prepare our resources, prepare our manpower," she said.
Emergency medicine specialist Dr Fua Tzay-Ping added: "It's always good to over-prepare ... from past experience, details may follow as the situation unfolds."
The hospital converted areas within its critical care zone to make room for incoming casualties, moving existing patients elsewhere in the department. Staff prepped child-sized equipment and dosages and deployed airway teams, plastic surgeons and neonatology staff before the first ambulance arrived.
It was the largest number of casualties from a fire that she had ever dealt with in her more than 20 years at SGH, Ms Muqtasidatum said.
"In the back of my mind, I knew that it was going to be a very stressful and challenging situation where we needed to get our resources correct," she said. "We'd have to make quick decisions."
To streamline care, a senior physician and senior nurse were assigned to specific cases, with an additional nurse circulating to assist. Once stabilised, paediatric patients were transferred to KKH for further treatment.
WAVE OF SADNESS
While clinical focus remained the priority during the emergency, emotional tolls emerged later.
"Caring for the surge of critically ill paediatric patients was mentally challenging as many of the staff are parents of young children as well," said Dr Fua.
The hospital conducted a debrief to help staff process the event. Dr Fua described a wave of sadness that came after her shift, once she watched the viral videos of the fire.
"When we are working ... you just think of it as a fire," she said. But the human cost became real later, and she "felt very deep sadness for all those who were affected".
She is relieved that her team managed to do its best for every victim, and remains grateful to bystanders who helped in the rescue.