Featured Research

from universities, journals, and other organizations

Military experts provide civilian surgeons with guidance on handling bomb blast injuries

Date:
November 22, 2010
Source:
Wiley - Blackwell
Summary:
Hospitals all over the world need to be aware of how to treat emergency blast injuries and military surgeons can provide valuable knowledge and advice to their civilian counterparts based on their experience of battlefield injuries.

Hospitals all over the world need to be aware of how to treat emergency blast injuries and military surgeons can provide valuable knowledge and advice to their civilian counterparts based on their experience of battlefield injuries. That is the driving force behind two papers published online by BJS, the British Journal of Surgery.

Related Articles


"The current inquest into the 2005 London bombings -- and the recent international security alerts -- provide a timely reminder that surgeons could be called on at a moment's notice to deal with blast injuries" says consultant surgeon Mr Jonothan Earnshaw, joint Editor-in-Chief of the journal. "That is why we believe that these papers are required reading for any surgeons who could find themselves dealing with the aftermath of a terrorist attack."

Military surgeons from the Royal Centre for Defence Medicine at the Queen Elizabeth Hospital Birmingham, UK, reviewed all cases of vascular trauma in battle injured service personnel over a five-year period ending January 2008. They used data collated by the Joint Theatre Trauma Registry, which covers all members of HM Armed Forces who have received acute trauma care as a result of the conflicts in Iraq and Afghanistan.

They found that 110 of the 1,203 patients sustained injuries to named vessels and that 60 per cent died before there was an opportunity for surgical intervention, including all 25 patients who sustained major vascular injuries to the abdomen or thorax.

Just under half of the 76 soldiers who suffered vascular injuries to their upper or lower limbs survived long enough for surgery, with one post-operative death among the 37 patients. Interventions on 38 limbs included 15 amputations, four vessel litigations and 19 definitive limb revascularisation procedures. Four of these latter procedures were not successful, leading to three further amputations.

"Amputation or vessel litigation is often required to control damage or save the lives of operable, but critically injured, patients with extremity injuries, but good limb salvage rates can be achieved in casualties able to withstand revascularisation" says co-author Lieutenant Colonel Nigel Tai. "Despite marked progress in battlefield trauma care, surgery is rarely an option in vascular injuries to the torso."

The authors say that their study has led to a number of conclusions regarding military vascular injuries:

  • Torso vascular injuries are highly lethal and very few patients will survive long enough for surgery.
  • While neck wounds are less immediately fatal, the number of patients dying after surgery is high when the major cause of the injury is a blast or multiple vessels are injured.
  • Peripheral vascular injuries are less fatal, but often occur in conjunction with trauma to other vital organs and that combination can lead to death.
  • Casualties with isolated extremity vascular injuries will usually survive to reach hospital, if the bleeding has been controlled, and less than half of cases will have anatomic and physiologic factors that indicate immediate amputation. Limb revascularisation can often be carried out successfully when such factors are not present.

In their paper on abdominal trauma in primary blast injury (PBI) Lieutenant Colonel Jeff Garner and colleagues from the Rotherham NHS Foundation Trust, UK, reviewed 61 research papers. Nine of these provided sufficient information to enable them to calculate the incidence of abdominal PBI.

"Blast injuries are not common in civilian settings and poorly understood by most clinicians who work outside areas of active warfare" says Lieutenant Colonel Garner. "Primary blast injuries result from the interaction of the blast wave with the body and typically affect gas-containing organs such as the ears, lungs and the gastrointestinal tract. The aim of our study was to investigate injuries sustained to the abdomen following primary blast exposure."

Key findings of the review included:

  • Secondary abdominal blast injury from penetrating fragments and pulmonary PBI are more common in blast injuries and of greater concern than abdominal PBI in most circumstances.
  • However, abdominal PBI has the potential for significant death and illness, as problems may present many days after blast exposure. For example, a gastrointestinal mural haematoma may perforate up to 14 days after injury.
  • Experimental evidence exists to help surgeons decide which mural haematomas are at most risk of delayed perforation and need to be resected to minimise this risk.
  • The incidence of abdominal PBI rates in survivors following air blasts ranged from 1.3 to 33 per cent, with an overall incidence of three per cent. Incidence rates were higher when blasts took place in enclosed spaces (6.7 per cent) than open spaces (5.6 per cent) and could reach up to 69 per cent in underwater blasts.
  • The terminal ileum and caecum were the most commonly affected organs.
  • Surgical treatment of abdominal PBI is similar to abdominal trauma resulting from other causes.

"Over the past two decades we have witnessed mass casualty bombings across the world" says Lieutenant Colonel Garner. "These incidents underline the importance of civilian surgeons having a good understanding of the pathophysiology of blast injuries. Studying injuries sustained during armed conflicts provides valuable insight into this area of emergency medicine."


Story Source:

The above story is based on materials provided by Wiley - Blackwell. Note: Materials may be edited for content and length.


Journal Reference:

  1. A. Stannard, K. Brown, C. Benson, J. Clasper, M. Midwinter, N. R. Tai. Outcome after vascular trauma in a deployed military trauma system. British Journal of Surgery, 2010; DOI: 10.1002/bjs.7359

Cite This Page:

Wiley - Blackwell. "Military experts provide civilian surgeons with guidance on handling bomb blast injuries." ScienceDaily. ScienceDaily, 22 November 2010. <www.sciencedaily.com/releases/2010/11/101122093103.htm>.
Wiley - Blackwell. (2010, November 22). Military experts provide civilian surgeons with guidance on handling bomb blast injuries. ScienceDaily. Retrieved December 22, 2014 from www.sciencedaily.com/releases/2010/11/101122093103.htm
Wiley - Blackwell. "Military experts provide civilian surgeons with guidance on handling bomb blast injuries." ScienceDaily. www.sciencedaily.com/releases/2010/11/101122093103.htm (accessed December 22, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Monday, December 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Christmas Kissing Good for Health

Christmas Kissing Good for Health

Reuters - Innovations Video Online (Dec. 22, 2014) Scientists in Amsterdam say couples transfer tens of millions of microbes when they kiss, encouraging healthy exposure to bacteria. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Brain-Dwelling Tapeworm Reveals Genetic Secrets

Brain-Dwelling Tapeworm Reveals Genetic Secrets

Reuters - Innovations Video Online (Dec. 22, 2014) Cambridge scientists have unravelled the genetic code of a rare tapeworm that lived inside a patient's brain for at least four year. Researchers hope it will present new opportunities to diagnose and treat this invasive parasite. Matthew Stock reports. Video provided by Reuters
Powered by NewsLook.com
Touch-Free Smart Phone Empowers Mobility-Impaired

Touch-Free Smart Phone Empowers Mobility-Impaired

Reuters - Innovations Video Online (Dec. 21, 2014) A touch-free phone developed in Israel enables the mobility-impaired to operate smart phones with just a movement of the head. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com
Earthworms Provide Cancer-Fighting Bacteria

Earthworms Provide Cancer-Fighting Bacteria

Reuters - Innovations Video Online (Dec. 21, 2014) Polish scientists isolate bacteria from earthworm intestines which they say may be used in antibiotics and cancer treatments. Suzannah Butcher reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins