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Emergency War Surgery

Emergency War Surgery

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Published by The Insider

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Published by: The Insider on Mar 04, 2011
Copyright:Attribution Non-commercial


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The success of any military health care system in wartime is directly related to thenumber of casualties adequately treated and returned to duty with their units. This must beaccomplished as soon and as far forward in the theater of operations as possible.The Second Battle of Bull Run near Manassas, Virginia, was one of the majorengagements of the United States Civil War. Three days after that great battle, three thousandwounded men still lay on the field. Relatives traveled to the front and took their loved oneshome for treatment rather than leave them to the uncertain ties of military medicine. We havemade phenomenal progress in the century since that battle occurred.I have had the privilege of being a physician for nearly forty years. Half of that time wasspent on active duty in the military services and the other half was spent in the civilian sector. Ihave participated in the delivery of health care in every conceivable setting: in a battlefield tentin Korea; on a hospital ship; in an air squadron; from austere county and state hospitals to large,glossy high technology institutions. I have seen people strive for, and achieve, excellence in allthose settings. I see it now in the military health care system, and no one is more proud than I of the accomplishments and the quality of that system and of the special type of men and womenwho make the system work. Our system is not without its problems and its frustrations. It takesa long time for equipment to be delivered; the personnel system doesn't always provide theproper mix of people in a timely manner to get the job done; but with rare exceptions, themedical mission is accomplished in exceptional fashion.This handbook should serve as a constant reminder that ours is a high calling. We arehere to save lives, not to destroy them. We are committed to the future, not the past, and to theprimary mission of military medicine, which is to keep the soldiers, sailors, airmen and marinesalive and whole: in the words of Abraham Lincoln, to minister to "him who has borne the bruntof battle."This revised edition represents the contributions of talented and gifted healthprofessionals from the military services as well as from the civilian sector. All who contributedhave the grateful appreciation of the editorial board for the enthusiasm, dedication, andperseverance which made this revision possible.WILLIAM MAYER, M.D.
This edition of the Emergency War Surgery Handbook is written for and dedicated to thenew generation of young, as yet untested surgeons, who may be given the opportunity and thehonor of ministering to the needs of their fallen fellow countrymen. What is the likelihood thatyou will be called to serve? The ancient Plato provided the answer: "Only the dead have seenthe end of war!"Will you be adequate, will you be successful in salvaging the lives and limbs of thosecomrades by applying the principles of the lessons hard-learned by countless generations of combat surgeons that have preceded you? The answer is a resounding yes, for "I would remindyou how large and various is the experience of the battlefield and how fertile the blood of warriors in the rearing of good surgeons" (T. Clifford Albutt).What sort of wounds will you be expected to manage? The Wound Data and MunitionsEffectiveness Team (WDMET) data derived from the Vietnam battlefield provide some insightinto the types of wounds and the casualty mix that might be expected. The WDMET dataindicate that 100 combat casualties, who survive long enough to be evacuated from the field,could be statistically expected to present the following casualty mix:Thirty casualties with minor or superficial wounds, minor burns, abrasions, foreignbodies in the eye, ruptured eardrums, and deafness.Sixteen with open, comminuted fractures of a long bone, of which several will bemultiple and several will be associated with injury of named nerves.Ten with major soft tissue injury or burns requiring general anesthesia for debridement.Several will have injury of named nerves.Ten will require laparotomy, of which two will be negative and several will involveextensive, complicated procedures.Six with open, comminuted fractures of the hand, fingers, feet, or toes.Five will require closed thoracostomies and soft tissue wound management; at least onewill have a minithoracotomy.Four will have major multiple trauma, i.e., various combinations of craniotomies,thoracotomies, laparotomies, amputations, vascular reconstructions, soft tissue debridements, orfracture management.Three will be major amputations (AK, BK, arm, forearm). In three out of four, thesurgeon will simply complete the amputation.Three craniotomies. Two will be craniectomies for fragments and one will involveelevation of a depressed fracture.ii

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