Emergency War Surgery

The Survivalist's Medical Desk Reference

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• Publisher: Skyhorse
• Year: 2012
• Print ISBN: 9781616083908
• eBook ISBN: 9781626366459
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

Military surgeons must assume a leadership role in combat casualty care in circumstances that are far less than ideal. This handbook provides much of the information needed to tackle these issues and features state-of-the-art principles and practices of forward trauma surgery as used by military physicians in far flung locations around the globe. Featuring nearly 200 illustrations demonstrating proper techniques, Emergency War Surgery is the most trusted and up-to-date manual offered by the Department of Defense for military medical personnel in the field.

Chapter 1

Weapons Effects and Parachute Injuries

Just as with any medical topic, surgeons must understand the pathophysiology of war wounds in order to best care for the patient.

Treat the wound, not the weapon.

Epidemiology of Injuries

• Weapons of conventional war can be divided into explosive munitions and small arms.

Explosive munitions: artillery, grenades, mortars, bombs, and hand grenades.

Small arms: pistols, rifles, and machine guns.

• Two major prospective epidemiological studies were conducted during the 20^th century looking at the cause of injury as well as outcome.

During the Bougainville campaign of World War II, a medical team was sent prospectively to gather data on the injured, including the cause of injury. This campaign involved primarily infantry soldiers and was conducted on the South Pacific island of Bougainville during 1944.

US Army and Marine casualties from the Vietnam War collected by the Wound Data and Munitions Effectiveness Team (WDMET) in Vietnam.

US Casualties, Bougainville Campaign (WW II) and Vietnam

Weapon	Bougainville %	Vietnam %
Bullet	33.3	30
Mortar	38.8	19
Artillery	10.9	3
Grenade	12.5	11
Land mine/booby trap	1.9	17
RPG (rocket propelled grenade)	—	12
Miscellaneous	2.6	—

The most common pattern of injury seen on a conventional battlefield is the patient with multiple small fragment wounds of the extremity.

Anatomical Distribution of Penetrating Wounds (%)

Mechanism of Injury

For missile injuries, there are two areas of projectile-tissue interaction, permanent cavity and temporary cavity (Fig. 1-1).

Fig. 1-1. Projectile–tissue interaction, showing components of tissue injury.

Permanent cavity. Localized area of cell necrosis, proportional to the size of the projectile as it passes through.

Temporary cavity. Transient lateral displacement of tissue, which occurs after passage of the projectile. Elastic tissue, such as skeletal muscle, blood vessels and skin, may be pushed aside after passage of the projectile, but then rebound. Inelastic tissue, such as bone or liver, may fracture in this area.

• The shock (or sonic) wave (commonly mistaken for the temporary cavity), though measurable, has not been shown to cause damage in tissue.

Explosive munitions have three mechanisms of injury (Fig. 1-2):

Fig. 1-2. The probability of sustaining a given trauma is related to the distance from the epicenter of the detonation.

• Ballistic.

Fragments from explosive munitions cause ballistic injuries.

Fragments are most commonly produced by mortars, artillery, and grenades.

Fragments produced by these weapons vary in size, shape, composition, and initial velocity. They may vary from a few milligrams to several grams in weight.

Modern explosive devices are designed to spread more uniform fragments in a regular pattern over a given area.

Fragments from exploding munitions are smaller and irregularly shaped when compared to bullets from small a...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Dedication
• List of Tables
• Editorial & Production
• Editorial Board
• Contributors
• Acknowledgments
• Foreword
• Preface
• Prologue
• Envoi
• Chapter 1: Weapons Effects and Parachute Injuries
• Chapter 2: Levels of Medical Care
• Chapter 3: Triage
• Chapter 4: Aeromedical Evacuation
• Chapter 5: Airway/Breathing
• Chapter 6: Hemorrhage Control
• Chapter 7: Shock and Resuscitation
• Chapter 8: Vascular Access
• Chapter 9: Anesthesia
• Chapter 10: Infections
• Chapter 11: Critical Care
• Chapter 12: Damage Control Surgery
• Chapter 13: Face and Neck Injuries
• Chapter 14: Ocular Injuries
• Chapter 15: Head Injuries
• Chapter 16: Thoracic Injuries
• Chapter 17: Abdominal Injuries
• Chapter 18: Genitourinary Tract Injuries
• Chapter 19: Gynecologic Trauma and Emergencies
• Chapter 20: Wounds and Injuries of the Spinal Column and Cord
• Chapter 21: Pelvic Injuries
• Chapter 22: Soft-Tissue Injuries
• Chapter 23: Extremity Fractures
• Chapter 24: Open-Joint Injuries
• Chapter 25: Amputations
• Chapter 26: Injuries to the Hands and Feet
• Chapter 27: Vascular Injuries
• Chapter 28: Burn Injuries
• Chapter 29: Environmental Injuries
• Chapter 30: Radiological Injuries
• Chapter 31: Biological Warfare Agents
• Chapter 32: Chemical Injuries
• Chapter 33: Pediatric Care
• Chapter 34: Care of Enemy Prisoners of War/Internees
• Appendix 1: Principles of Medical Ethics
• Appendix 2: Glasgow Coma Scale
• Appendix 3: Theater Joint Trauma Record
• Index