Independent italian ngo founded in EMERGENCY. Promotes a culture of peace, solidarity and respect for human rights.

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Melanie Hunt
5 years ago
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2 Independent italian ngo founded in EMERGENCY Promotes a culture of peace, solidarity and respect for human rights. 2

3 34% 26% 17% 16% 7% The victims

4 War Victims WWI WWII after Combatants Civilians WWI WWII after

5 War is the worst public health tragedy

6 sofferenza

9 Assisting the victims is an emergency therapy

10 High velocity bullets

At impact, the empty cavity at the tip of the bullet is filled with lead that is pushed forward by the steel

13 E=MV 2 WOUND PROFILES AK-74 5,45x39 Vel. 910 m/s Wt. 3,45 g Example of small caliber, high velocity bullet developed by Soviet forces in the 70s. At impact, the empty cavity at the tip of the bullet is filled with lead that is pushed forward by the steel penetrator. This internal deformation creates a highly unstable bullet that tumbles almost immediately neck is less than 2 cm, note also the double tumbling and the 90 deviation at the track s end

15 3500 Kinetic energy of bullets (1) E (Joules) mm makarov 9mm luger 5,45x39 AK-74 5,56x45 M 193 7,62x39 AK-47 7,62mm NATO BLUE : energy at point blank RED : energy at 150m for the handguns calibers (the two 9mm) and at 300m for the rifles ammunitions YELLOW : minimum level of energy to create significant body damage (ca.150 J)

16 Head High mortality and morbidity CSF infection intracerebral abcesses sub-dural empyema

17 Maxillofacial

18 Neck

19 Chest

20 Abdomen

21 Soft Tissues

22 LANDMINES RPGs IEDs EXPLOSIONS ARTILLERY SHELLS Terrorist attacks Suicide bombers

23 Antipersonnel mines

24 Limbs

25 Fragmentation Blast Types of Antipersonnel Mines

26 SB-33, Italy

Coupland Proximally the damage, especially to soleus, is always much more than what is

27 Wounding mechanism of landmines- THE UMBRELLA EFFECT When the skin has returned to position, the extent of proximal damage is hidden From R.Coupland Proximally the damage, especially to soleus, is always much more than what is visible. Be prepared to climb up during DBR, muscle necrosis can be found proximally (yellow dotted line) to wound edges even underneath intact skin

28 Valmara 69, Italy

$femur fracture$ Intact feet r.

30 Wounding mechanism of landmines - THE BOUNDING MINE R femur fracture Multiple STWs Intact feet r. Femoral art. lesion Deep L arm STWs

31 Shrapnel from bombs or rockets

33 Burns

34 1 Km/s IEDs Improvised Explosive Devices

IEDs Improvised Explosive Devices Young boy, typical victim of an IED in Helmand Province Note the severity of soft tissue injuries Often, fabric, wood, metal pieces, nails, bolts, nuts are found

35 IEDs Improvised Explosive Devices Young boy, typical victim of an IED in Helmand Province Note the severity of soft tissue injuries Often, fabric, wood, metal pieces, nails, bolts, nuts are found deeply embedded in the wounds and require meticulous surgical technique for proper management and very often, repeated DBRs Most common device used in recent years in Afghanistan Custom made using existing explosive from military ordnances or by producing from scratch the explosive with available materials Over 65% of ISAF forces casualties are attributable to IEDs Extremely variable effectiveness, but considered very dangerous for civilian population due to their widespread use Can be used as booby-traps or be activated remotely by electronic devices including cell phones

38 ?

TO AMBROISE PARE (1510-1590 AD) SINCE THEN, SCORES OF SURGEONS DISCOVERED THE

39 HISTORICAL PERSPECTIVE SURGERY WAS BORN AND THRIVED ON THE BATTLEFIELDS THE IDEA THAT A SURGEON SHOULD BE GENTLE WITH SOFT TISSUES IN WAR WOUNDS CAN BE TRACED BACK TO AMBROISE PARE ( AD) SINCE THEN, SCORES OF SURGEONS DISCOVERED THE LESSONS OF WAR ONLY FOR THESE LATTER TO BE FORGOTTEN BY THE NEXT GENERATION OF SURGEONS

AT THE BEGINNING OF WWI THE BRITISH SURGEONS BROUGHT TO THE BATTLEFIELD

WAS REINSTITUTED BY ORDER OF THE HIGHEST LEVEL OF COMMAND IN THE MEANTIME,

HEALTHY SOFT TISSUES AT THE BEGINNING OF WWII, THE NEWCOMER WAS PENICILLIN

40 AT THE BEGINNING OF WWI THE BRITISH SURGEONS BROUGHT TO THE BATTLEFIELD THEIR FAITH IN LISTER S CARBOLIC ACID TO CONTROL INFECTION, AND THEY ABANDONED THE PRACTICE OF DEBRIDEMENT.AT SUCH A HIGH COST IN TERMS OF INFECTIOUS COMPLICATIONS THAT DEBRIDEMENT WAS REINSTITUTED BY ORDER OF THE HIGHEST LEVEL OF COMMAND IN THE MEANTIME, CARREL AND DAKIN WERE LOOKING FOR AN IRRIGATION FLUID THAT WAS HARMLESS TO HEALTHY SOFT TISSUES AT THE BEGINNING OF WWII, THE NEWCOMER WAS PENICILLIN ON THE ALLIED SIDE AND, ONCE AGAIN, DEBRIDEMENT WAS TEMPORARILY ABANDONED JUST TO BE ALMOST IMMEDIATELY BROUGHT BACK

41 The treatment of war wounds is based on well established principles Although new technologies have been brought to war theater medical facilities the basic surgical principles discovered during the wars of the last century are still valid today. Indeed, they remain the most important steps in the proper care of war wounds: Initial debridement and Irrigation

42 Water is poured from above and flows in a basin The water in the basin should not be re-used Soft brush or gauze may be used with soap Optimal wound area washing is better done with patient under anesthesia Assistant holds limb in physiological position

61 5 days later

67 BASIC PRINCIPLES of SURGERY for WAR WOUNDED Good prehospital care ABC resuscitation Good debridement Leave wound OPEN NO unnecessary dressing changes Delayed Primary Closure (DPC) after 5 days Antibiotics (adjuvant) Analgesics Nutrition Physiotherapy & Rehabilitation

68 Grazie

Original Article Facial Gunshot and Blast Injuries Pak Armed Forces Med J 2016; 66(4):515-19

Original Article Facial Gunshot and Blast Injuries Pak Armed Forces Med J 2016; 66(4):515-19 PATTERN OF FACIAL GUNSHOT AND BLAST INJURIES AMONGST LAW ENFORCING FORCES Muhammad Nazir khan, Syed Amjad Shah*,