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Rescue operation Early coordination of the rescue e ff ort allows optimal use of resources. The first priority is to prevent further damage from occurring, both to people and to the infrastructure. The types of injuries encountered by rescue workers depend on ...

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SEQUENCE OF RELIEF EFFORTS AFTER A DISASTER Establishing a chain of command Many countries have dedicated organisations that deal with disasters. In other countries, an administrative hierarchy is established to coordinate the teams participating in relief e ff...

SEQUENCE OF RELIEF EFFORTS AFTER A DISASTER Establishing a chain of command Many countries have dedicated organisations that deal with disasters. In other countries, an administrative hierarchy is established to coordinate the teams participating in relief e ff...

SPECIFIC ISSUES There is no injury that is peculiar to disasters and the whole spectrum of external injuries from minor cuts and compound fractures to amputations is seen. Internal organ damage is frequent and, unless immediate help is available, this account...

Tetanus This potentially fatal condition, also called ‘lockjaw’, is caused by Clostridium tetani , a Gram-positive spore-forming bacillus occurring naturally in the intestines of humans and in the soil. It enters the body through a wound and replicates, thrivi...

Triage Derived from the French verb trier , triage means ‘to sort’ and is the cornerstone of the management of mass casualties. It aims to identify those patients who will benefit the most by being treated the earliest, ensuring ‘the greatest good for the gre...

BLAST INJURIES Blast injuries are classified by the blast mechanism ( Table 34.3 BLAST INJURIES Blast injuries are classified by the blast mechanism ( Table 34.3 BLAST INJURIES Blast injuries are classified by the blast mechanism ( Table 34.3

BLAST As already discussed, blast has become the predominant mechanism of injury in recent conflicts. Unfortunately , terror ist attacks within urban centres mean that these injuries are increasingly encountered within civilian practice. While explosives come ...

Ballistic injuries Terminal ballistics (or wound ballistics) describes the interac tion between projectiles and target tissue. This interaction and subsequent transfer of energy cause injury . The kinetic energy of the bullet is related to the mass and veloc...

CONSIDERATIONS International Humanitarian Law (IHL) regulates humanitar - ian issues during armed conflict. Modern IHL is derived from a variety of sources, notably the Geneva Conventions and their additional protocols, along with further specific regulations f...

Complex dismounted blast injury In contrast, the dismounted IED casualty may sustain a char acteristic pattern of injuries, including lower limb amputation, pelvic fracture and genital, perineal and rectal injuries. The most common cause of death in such cas...

DAMAGE CONTROL SURGERY 15 DCS was first described by Rotondo et al ., although the idea of an abbreviated laparotomy for the unwell patient was not totally novel. The concepts of DCS were initially applied to complex trauma patients with combined vascular an...

DECISION MAKING WITHIN THE DEPLOYED ENVIRONMENT The damage control approach is vital in a proportion of war injuries, but thought must be given to available resources. Within a well-established role 3 unit, both DCS and definitive procedures are likely to be p...

ETHICAL AND LEGAL ETHICAL AND LEGAL ETHICAL AND LEGAL

Environmental effects As already alluded to, the shockwave of blast overpressure is modified by an enclosed or partially enclosed space. Envi ronmental variations may make marked di ff erences to injury rates and clinical presentations following blast. Higher r...

HOW IS WAR SURGERY DIFFERENT? While civilian trauma surgery bears some of the hallmarks of the battlefield, there are fundamental contrasts in environment and injury pattern that must be appreciated: /uni25CF The environment of war is likely to be austere. Wh...

INFECTION Battlefield wounds are by their very nature grossly contami - nated and the treatment and prevention of infection is one of the basic functions of war surgery . Wounds sustained during warfare are high-energy wounds with large areas of devitalised ...