War surgery in Afghanistan: a model for mass causalities in terror attacks?
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ORIGINAL PAPER
War surgery in Afghanistan: a model for mass causalities in terror attacks? F. Wichlas 1,2 & V. Hofmann 1 & G. Strada 2 & C. Deininger 1 Received: 19 June 2020 / Accepted: 1 September 2020 # The Author(s) 2020
Abstract Purpose The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise. Methods NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016–May 2016) were included. Patients´ characteristics were analyzed. Results The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation. Conclusion The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference. Keywords Low-income country . War surgery . Trauma surgery
Introduction Medical care in low-income countries (LIC) differs a from western medical standards [1]. Compared with civilian trauma in LIC, which is mainly caused by road traffic accidents, the injuries in war zones present different patterns with numerous wounds caused by bullets, mines, and bombs [2, 3]. In high-income countries (HIC), the surgical training focuses early on a specialty. This leads to high knowledge in a very narrow surgical field but a lack of broad general surgical experience [4–6]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00264-020-04797-2) contains supplementary material, which is available to authorized users. * F. Wichlas [email protected] 1
Department of Orthopedics and Traumatology, Paracelsus Medical University, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
2
Emergency NGO, Milan, Italy
The lack of surgical experience might not be relevant as long as a hospital provides a specialist for every probable pathology, but in cases of a sudden high volume of causalities like in a terror attack or train accident, adequate treatment of the injured could get difficult [7, 8]. In this setting, a specialist for every injured region in one patient would deplete human resources. Besides fast surgery in mass casualties, patients’ flow needs to be efficient, both in speed and direction. The in-hospital pathways must be clear for the personnel from the moment the patient enters the hospital to the final destination [9]. As much as medical standards in LIC
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