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Life-saving medical innovations and burn treatments from the Bali bombings, 20 years later

Twenty years after the Bali bombings sent shockwaves across Australia, Darwin nurse Ronnie Taylor still remembers the most common request from hospitalized survivors.

“Can you call my mother? Can you call my father? she says.

“You could see the relief. It’s like they’ve been on high alert for a few days and all of a sudden they just let go.

Bomb explosions in Kuta caused extensive damage.(AAP: Dean Lewins)
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Archive footage shows the destruction caused by the Bali bombings in 2002.

Just after 11 p.m. on October 12, 2002, terrorists detonated three suicide bombers in Bali: two in nightlife spots along the popular Kuta nightclub and one outside the US Consulate.

The deadly attacks claimed the lives of 202 people – including 88 Australians – and tested Australia’s top medical experts.

“We knew if people were going to have a chance of surviving, getting to Australia, Darwin was the best place to stop,” Ms Taylor said.

adf personnel transporting patients victims of the attacks in bali
Australian Defense Force personnel played a crucial role in evacuating patients. (Provided: National Critical Care and Trauma Response Center)

Heroic Efforts of Doctors and Nurses

As news of the bombings spread across Australia, healthcare staff at the Royal Darwin Hospital in the Northern Territory began preparing for an influx of patients.

Located a two and a half hour flight from Bali, the hospital only had 15 intensive care unit beds.

They were preparing for the arrival of more than 70 bombing victims, many with life-threatening injuries.

Dr Brian Spain, who helped coordinate the arrival of patients in Darwin for three days, said “I have absolutely never seen anything like it”.

hospitalized doctors treating patients in 2002
With many victims suffering from life-threatening injuries, urgent treatment was essential. (Provided: National Critical Care and Trauma Response Center)

“For a brief moment, it was overwhelming,” he said.

“But then realizing I had a great team…we knew we could do it, one person at a time.”

Dr Spain said the hospital had 26 hours to prepare for the first load of patients from the time the bombs went off.

“We brought in a burn surgeon and one of his trainees from Adelaide, so we had a really good team here to do the procedures and advise on the best treatment,” he said.

Man lying in hospital bed wrapped in blankets with doctors standing around
Many victims airlifted to Australia suffered horrific third-degree burns that extended to all layers of their skin. (Provided: National Critical Care and Trauma Response Center)

“While everyone felt deeply affected by the tragedy of the injuries suffered by everyone, there was a deep sense of pride amongst the staff. [that they were able to help]which remains to this day…that they were part of an amazing response [not only] for the hospital but on behalf of the nation to care for these victims.”

The Royal Australian Air Force delivered a flood of patients to hospital, while medical staff rushed to stabilize the injured and fly them back to their home countries for further treatment.

ADF staff help Bali bombing patients
For three days the hospital was filled with a rotation of injured Australians.(Provided: National Critical Care and Trauma Response Center)

“I still remember going up the ramp of that Hercules [aircraft] and just seeing it stacked with the first two bays of very badly injured people,” Dr Spain said.

“The other burns were literally [stacked] three high on military stretchers.”

A male doctor wearing an orange helmet in a hospital trauma unit
Dr Brian Spain said the team at the Royal Darwin Hospital had been “deeply affected” by the tragedy.(ABC News: Hamish Harty)

Opening Australia’s eyes to the burns

Dozens of patients who survived the Bali bombings were left with horrific third-degree burns that spread to every layer of their skin, destroying nerve endings and threatening vital organs.

Phil Britten lying in a hospital bed with his arms bandaged and tubes in his nose after being injured in the Bali bombings
Perth man Phil Britten suffered burns to 60% of his body.(Provided: Phil Britten)

Renowned burn specialist Dr Fiona Wood with her team at the Royal Perth Hospital has helped save 28 patients with her innovative technique known as ‘spray-on skin’.

The world’s first technology, which grows healthy skin cells and sprays them onto wounds, has dramatically reduced permanent scarring in burn victims.

“It was a time when the window to our world [of burns treatment] was opened,” Dr. Wood said.

“People understood the seriousness and shocking nature of burns, so that started a program where people supported us.”

Ms Wood was named Australian of the Year in 2005 for her help to those injured in the bombings and for her life-saving medical innovations that continue to help burn victims.

“We are trying to understand the power of tissue engineering and how we can use it to heal burns,” she said.

Fiona Wood dressed in gowns on a hospital balcony.
Dr Fiona Wood has become a household name after the Bali bombings.(Provided: Fiona Wood Foundation)
a gloved hand spraying liquid on a dark blue background
Dr. Wood’s “spray on skin” technology has been used around the world.(Provided: Fiona Wood Foundation)

Even with extensive burn management experience, Dr Wood said she was shocked by the extent of the blast injuries.

“Seeing the complexity of the Bali patient injuries was quite eye-opening,” Dr Wood said.

“The Bali bombing was a shock to Australia because it brought terrorism back home.”

a woman in a black dress crossing her arms
Dr Wood says the attacks have brought together burn experts across the country.(Provided: Fiona Wood Foundation)

From disaster came development

Dr Len Notaras, who was chief executive of the Royal Darwin Hospital at the time, said his team faced horrific injuries in difficult conditions, but all rose to the occasion.

“[There were] impalements, traumatic amputations, all sorts of horrible things that are products of war…but the response and the success of this particular response is one that every single individual involved that day should be very proud of.” he declared.

a man in his 60s or 60s sitting in a desk wearing a suit
Dr Len Notaras said the response of medical teams to the injured being airlifted to Australia was “incredible”.(ABC News: Leigh Brammall)

The challenge of coordinating an urgent and highly trained medical response to the bombings prompted the creation of the world-renowned National Critical Care and Trauma Response Center (NCCTRC).

“Before Bali [bombings]there were a lot of very talented resources across the country, but bringing it all together under one umbrella – and being able to respond under one umbrella – was key, Dr. Notaras said.

Since its inception in 2004, the center has been a key part of the Australian Government’s response to humanitarian disasters, on land and overseas.

Dr. Rob Cardwell
The centre’s medical teams were deployed to Fiji following Cyclone Winston in 2016.(Provided: National Critical Care and Trauma Response Center)
doctors in blue shirts giving aid to the people of fiji
Most of the cyclone victims in Fiji were children or the elderly.(Provided: National Critical Care and Trauma Response Center)
A boat near an arid landscape
The NCCTRC helped coordinate a response to the 2019 White Island Volcano eruption in New Zealand.(Supplied: New Zealand Defense Force)

From Black Summer bushfires and earthquakes to epidemics, cyclones and oil spills in Asia-Pacific, the center’s medical assistance teams have saved thousands of lives.

“For the Indo-Pacific and even the world, the arrival of our blue shirts and beige pants has generated significant respect,” Dr Notaras said.

Standing nurse in blue coat holding test tube and wearing mask.
The center has helped vaccinate Australians during the COVID-19 pandemic. (Provided: National Critical Care and Trauma Response Center )
healthcare personnel wearing blue shirts or military clothing climb the ramp to an airplane
NCCTRC health workers traveled to the Solomon Islands this year to help with coronavirus outbreaks.(Provided: National Critical Care and Trauma Response Center)
a blonde female doctor wearing a blue shirt talking to a woman PNG
Teams have also been deployed to help manage COVID-19 in Papua New Guinea in 2021. (Provided: National Critical Care and Trauma Response Center)

Ms Taylor, now head of strategic projects at the NCCTRC, said the center had come a long way since the horrors of the Bali bombings.

“I think it’s really important to remember how it happened and where we came from,” she said.

“I’m so proud of the response over those three days. It was amazing.”

blonde woman standing near red shopping bags
Ronnie Taylor says Australia’s medical progress since the attacks should be a source of national pride.(ABC News: Michael Franchi)