Katedra Anestezjologii i Intensywnej Terapii

Uniwersytetu Medycznego w odzi

Combat Injuries
Injuries
Shot wounds
Chest trauma
Autor: lek. Przemysaw Dobielski
Lek. Robert Guszcz

Levels of Medical Care in

War Zone

1.
2.
3.
4.
5.

There are five levels of care ( also known as roles )in the
battlefield based ,except first level, on MFTs (Medical Treatment
Facility)
Level I immediate first aid deli
delivered
vered at the scene by team or
platoon orderlies and medics along with other soldiers
Level II
II-- highly mobile medical facility,often airportable with
possible air deployment even, with capability of proviading lifelifesaving surgery and several inin-patient beds capacity
Level III the highest level of medical care available within the
combat zone where definitive surgical treatment of the injured is
carried out
Level IV
IV-- definitive medical and surgical care outside the combat
zone
Level V
V--based on NHS

Level I immediate first aid

delive
delivered
red at the scene
The golden rule of first aid
Remember that your safety is number one
priority acting carelessly not only does
not reduce casualties but also can
multiply them
Never hesitate to call additional help if only
available

Patient Assessment
Scene Size
Size--up
- Body Substance Isolation
- Scene Safety
- Consider Mechanism of Injury/Nature of
illness
- Determine the number of patients
- Consider additional resources
- Consider C
C--spine immobilization

Body Substance Isolation

(BSI)
Personal protective equipment (PPE) will
reduce your personal risk of injury or
illness.
Gloves , gowns, masks

Scene Safety
,, Any enviroment can potentially cause
damage to you, your team and your patients
Pay particular attention to
- Traffic
- Unstable surface
- Leaking fluids
- Broken utility poles and downed electrical wires
- Smoke or fire
- Hazardous and toxic materials

Consider Mechanism of
Injury/Nature of illness
To predict possible complications
Blunt trauma
Penetrating trauma

Determine the number of

patient
Triage

Consider additional
resources
BLS
ATS
Air medical support

There are three

requirments which war
time medics have to fulfill
High Professionalizm
Sound and quick judgement
Execptional Adaptability

The aims of war surgery

are :

Save life
Save limbs
Avoid infectious complications
Minimize residual disability

The outcome of war

surgery is influenced by ;

Type of injury
General condition of the patient
First aid
Time needed for transport to hospital
Quality treatment (surgery,post(surgery,post-operative care,
rehabilitation )
Possibility of evacuation to better equipped
hospital with more experienced staff

Ballistic
Shrapnels(splinters) from explosive
munitions cause ballistic injuries are
mortars
Fragments produced by these weapons
vary in size, shape, composition, and
initial velocity

Blast
The balst affects subjects in the close
vicinity of the explosion unlike balistic
injury which goes out much farther
The eardrum ruptures are most often
produced by the force of the blast
followed by lung injuries and the
gastrointestinal tract damage

Thermal
Combustion of powder as well as other
subsances in the munition sends out thermal
wave which produce burns within short
distance from the blast due to expontetially
dimishing force of the wave
May add and complicate other injuries.On its
own can cause immidiate death in case ,say,of
upper respiratory tract burns or delayed due
extensive external burns

Antipersonnel Landmines

Static
Bounding
Horizontal spray
IED ( improvised explosive device)
EFP (explosively formed penetrator )
VBED (vehicle borne explosive device)

Thoracic injuries
about 15 % of war injuries involve the
the chest
Of those 10 % are superficial ( soft tissue
only involved)
The remaining 90% of chest injuries are
in large part of penetrating nature

Anatomic considerations
Nipple line
(T4 level )

Thoracic injuries
The immediate recognition and treatment
of tension pneumothorax is the single
most important and lifesaving
intervention in the treatmnet of chest
injuries in combat.

Thoracic injuries
Signs of tension pneumothorax
- Distended neck veins
- Tracheal shift
- Decreased breath sounds
- Hyperresonance over the affected
hemithorax
- Hypotension is the cardinal sign
- None or all may be present