Injury Patterns in Conflict Settings: Difference between revisions
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== Introduction == | == Introduction == | ||
Depending on the situation the type of casualties expected by EMTs can vary. Understanding the situation on the ground and the burden of disease it creates is crucial to the planning of any intervention. Large waves of patients can be created both by disasters(earthquakes) or by conflicts (short term focused military interventions or terrorist attacks). In contrast some situations such as enduring conflicts (a long running civil war) or disasters (drought leading to famine) can create a steady long term flow of patients. A primary goal of the WHO's EMT Initiative isto aid governments and EMTs in delivering the appropriate type of medical surge capacity that a situation requires. This can best be understood by thinking about burden of disease in waves. | |||
== Injury Types in Sudden Onset Disasters == | == Injury Types in Sudden Onset Disasters == | ||
=== Implications for Rehabilitation === | |||
==== Earthquakes ==== | |||
Earthquakes are some of the highest profile situations that EMTs can respond to. Their relative unpredictability, combined with the obvious destruction of buildings and infrastructure make these events widely reported and often widely responded to. It is crucial for EMTs to understand the needs and limitations of earthquakes when deciding whether to respond to these events. » The patient load and demand on EMTs can differ widely depending on the degree of preparation of the society prior to the event. » Earthquakes carry a low death-to-injury ratio with approximately 1 death for every 3 injuries, meaning that surgical response can result in decreased morbidity and mortality by treating wounds and fractures. » Earthquake victims frequently present with crush type injuries that can progress to crush syndrome. This clinical scenario can present some difficult management challenges, particularly for those inexperienced in dealing with these types of injuries. Management may require ICU care or even dialysis. » The collapse of structures brought on by earthquakes changes the nature of the demands for EMTs. If healthcare facilities are destroyed then the demand for more advanced, totally selfsufficient type 2 and 3 EMTs becomes greater. | |||
TSUNAMIS » Tsunamis create a much different context compared to earthquakes. They carry a much higher mortality ratio of approximately 9 deaths for every 1 injury. » The relatively small number of injured patients means that fewer surgical teams are needed. However, they may demand other types of EMTs such as medical or public health teams. » The surgical need that does exist following a tsunami tends to center around soft tissue injuries and infections sustained during the event or the immediate aftermath. These wounds are made worse by continuous exposure to wet, contaminated conditions. » There may be some role for bolstering local surgical capacity by EMTs that can deploy temporary structures while local structures are being rehabilitated, as the aftermath of Tsunamis can involve significant structural damage due to either the tsunami itself or the inciting earthquake. However, this need should not be assumed to be present unless the host government issues a specific request. FLOODS » The need for a surgical response and the factors affecting what types of EMTs would be of greatest value are highly dependent on the cause of the flood, the state of health-care facilities and the rapidity of the flooding. | |||
== Injury Types in Conflict == | == Injury Types in Conflict == | ||
injuries inflicted in conflict settings are very different to those encountered in the civilian population but currently there is no international humanitarian trauma registry and data describing the needs of those injured during conflict are inadequate to support the development of humanitarian trauma systems. <ref name=":0">Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. Epidemiology of injuries sustained by civilians and local combatants in contemporary armed conflict: an appeal for a shared trauma registry among humanitarian actors. World journal of surgery. 2020 Jun;44(6):1863-73. | |||
[[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | </ref> <ref name=":1">Sargent W, Wild H, Mayhew E, Wren SM. Counting the costs of trauma: the need for a new paediatric injury severity score. Lancet child and adolescent health, The. 2021;5(6):391-2.</ref> A key challenge specific to conflict is that they can deliver a steady tide of patients that ebbs and flows based on the situation on the ground. | ||
[[Category:Rehabilitation]] | [[Category:Rehabilitation in Disaster and Conflict Situations Content Development Project]] | ||
[[Category:Rehabilitation]] | |||
[[Category:Projects]] | [[Category:Projects]] | ||
[[Category:Course Pages]] | [[Category:Course Pages]] | ||
[[Category:Physioplus Content]] | [[Category:Physioplus Content]] | ||
[[File:Mechanisms and anatomic regions of injury.jpeg|thumb|412x412px|'''Figure.1''' Mechanisms and Anatomic Regions of Injury; '''a''' Comparison between US military Personnel and '''b''' Comparison between Conflict Settings]]A recent systematic review analysed 49 reports describing injuries sustained by civilians and local combatants in twenty-first century armed conflict representing 18 conflicts, and 58,578 patients including the Middle East (Afghanistan, Iraq, Israel, Palestine, Kuwait, Pakistan, Syria), North Africa (Libya, Egypt), and Sub-Saharan Africa (Nigeria, Central African Republic). These injuries were treated in a wide range of facilities including Military Facilities (30.6%), local academic health centre (20.4%), government or public hospitals (16.3%) and humanitarian organisations (12.2%). The majority of patients were male (79.3%) with a median age of 26 years, and 34.7% under 18 years.<ref name=":0" /> | |||
Blast injuries, including those from bombs, missiles, grenades, mortars, landmines, improvised explosive devices, unexploded ordnance or explosive remnants of war were more common in rural settings (70%) and accounted for 70.1% of overall injuries, followed by gun shot wounds with 22%, which were more common in urban (42.2%) and semi-urban (26.7%) areas. Other mechanisms of injury included blunt trauma (4.1%), assault (3.9%), unspecified penetrating trauma (3.4%) and burns (3.3%) with the largest number of injuries occurring to the extremities (33.5%). Overall the data also highlights that civilians bear a significant burden of morbidity and mortality in conflict zones. Moreover, paediatric patients sustain a substantial proportion of conflict-related injuries, with children accounting for 34.7% of injured patients. <ref name=":0" /> The number of children injured is in line with other international research, which shows that children constitute 30% of seriously injured patients requiring surgical intervention in humanitarian hospitals in conflict zones. Between 2011 and 2016, more than a quarter of Syrian barrel bomb victims were children<ref>Guha-Sapir D, Schlüter B, Rodriguez-Llanes JM, et al. Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011–2016. Lancet Glob Health. 2018;6:e103–e110. doi: 10.1016/S2214-109X(17)30469-2.</ref>, while 40% of patients treated at an MSF Hospital in Syria during a 2017 offensive were under the age of 18 years <ref>OKeeffe J, Vernier L, Cramond V, et al. The blast wounded of Raqqa, Syria: observational results from an MSF-supported district hospital. Confl Health. 2019;13:28. doi: 10.1186/s13031-019-0214-0.</ref>. The implications of this further highlight the need for rehabilitation services to be adequately resourced with paediatric equipment and for rehabilitation professionals to have some paediatric expertise including some understanding of these types of injuries on children.<ref>Ankomah J, Stewart BT, Oppong-Nketia V, et al. Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana. J Pediatr Surg. 2015;50:1922–1927. doi: 10.1016/j.jpedsurg.2015.03.047.</ref><ref name=":1" /> | |||
=== Implications for Rehabilitation === | |||
Injuries sustained in conflict and terrorist attacks present unique challenges, which differ from those seen in disasters, and are also rarely experienced in day-to-day practice away from the conflict zones. Working in situations of conflict, it is important to understand what weaponry is commonly used and the typical injury patterns and surgical and rehabilitation implications. | |||
The concept of ballistics and energy transfer plays an important role in understanding tissue damage in conflict zones, with the level of tissue damage dependant on the efficiency of the energy transfer of the missile – whether this be a bullet or blast fragment. <ref name=":2">Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters. Handicap International: London, UK. 2020.</ref>You can read more about ballistics and energy transfer in the ICRC and AO Foundation Field Guide ‘[https://icrc.aoeducation.org/files/downloads/A_Field_Guide_Low_res.pdf Management of Limb Injuries during Disasters and Conflicts.] | |||
==== Knifes / Machete ==== | |||
A machete is long knife with a sharp edge, a broad blade and a thick back that may be either curved or straight. Like a knife they are readily available in many homes and is used used as a multipurpose tools used in the farm, home and construction sites are and can be used as a close range weapon within conflict settings. The types of injuries from knives and machetes vary depending on the mode in which they are used (stabbing or cutting), the part of the blade that is used (sharp of dull edge) and whether the injury was accidental or intentional.<ref name=":3">Omoke NI, Madubueze CC. Machete injuries as seen in a Nigerian teaching hospital. Injury. 2010 Jan 1;41(1):120-4. | |||
</ref> | |||
Knives and machetes generally cause multiple injuries, which can include streak-like bruises, lacerations, transection of nerves, vessels and tendons, puncture wounds including to organs with long knives and machetes able to cause a through-and-through perforating wound and can be capable of slicing through bone resulting in open fractures, subtotal decapitation and traumatic amputations. Given the multipurpose use of knives and machetes they also carry a night risk for infections following injury, and a possible source of gangrene and tetanus. <ref name=":3" />Lacerations were the most common injury from a machete (51.35%), with the head the most common site (46%), followed closely by the upper extremity (44%) with 19.2% of those tendon injuries in the hand and worst, most commonly seen in someone trying to protect the head from being hit.<ref name=":3" /> | |||
Rehabilitation professionals should be aware of the high risk for wound infection, and be aware of the psychological trauma that is commonly associated with this type of injury. Given the high incidence of lacerations to the head, traumatic brain injury should also be considered.<ref name=":2" /> | |||
==== Bullet Wounds ==== | |||
==== Explosive Weapons ==== | |||
Nuclear | ==== Chemical, Biological, Nuclear ==== | ||
== Heading 3 == | == Heading 3 == | ||
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== Resources == | == Resources == | ||
[https://icrc.aoeducation.org/files/downloads/A_Field_Guide_Low_res.pdf Management of Limb Injuries during Disasters and Conflicts.] | |||
== References == | == References == | ||
see [[Adding References|adding references tutorial]]. | see [[Adding References|adding references tutorial]]. | ||
<references /> | <references /> | ||
Revision as of 17:52, 27 February 2022
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Introduction[edit | edit source]
Depending on the situation the type of casualties expected by EMTs can vary. Understanding the situation on the ground and the burden of disease it creates is crucial to the planning of any intervention. Large waves of patients can be created both by disasters(earthquakes) or by conflicts (short term focused military interventions or terrorist attacks). In contrast some situations such as enduring conflicts (a long running civil war) or disasters (drought leading to famine) can create a steady long term flow of patients. A primary goal of the WHO's EMT Initiative isto aid governments and EMTs in delivering the appropriate type of medical surge capacity that a situation requires. This can best be understood by thinking about burden of disease in waves.
Injury Types in Sudden Onset Disasters[edit | edit source]
Implications for Rehabilitation[edit | edit source]
Earthquakes[edit | edit source]
Earthquakes are some of the highest profile situations that EMTs can respond to. Their relative unpredictability, combined with the obvious destruction of buildings and infrastructure make these events widely reported and often widely responded to. It is crucial for EMTs to understand the needs and limitations of earthquakes when deciding whether to respond to these events. » The patient load and demand on EMTs can differ widely depending on the degree of preparation of the society prior to the event. » Earthquakes carry a low death-to-injury ratio with approximately 1 death for every 3 injuries, meaning that surgical response can result in decreased morbidity and mortality by treating wounds and fractures. » Earthquake victims frequently present with crush type injuries that can progress to crush syndrome. This clinical scenario can present some difficult management challenges, particularly for those inexperienced in dealing with these types of injuries. Management may require ICU care or even dialysis. » The collapse of structures brought on by earthquakes changes the nature of the demands for EMTs. If healthcare facilities are destroyed then the demand for more advanced, totally selfsufficient type 2 and 3 EMTs becomes greater.
TSUNAMIS » Tsunamis create a much different context compared to earthquakes. They carry a much higher mortality ratio of approximately 9 deaths for every 1 injury. » The relatively small number of injured patients means that fewer surgical teams are needed. However, they may demand other types of EMTs such as medical or public health teams. » The surgical need that does exist following a tsunami tends to center around soft tissue injuries and infections sustained during the event or the immediate aftermath. These wounds are made worse by continuous exposure to wet, contaminated conditions. » There may be some role for bolstering local surgical capacity by EMTs that can deploy temporary structures while local structures are being rehabilitated, as the aftermath of Tsunamis can involve significant structural damage due to either the tsunami itself or the inciting earthquake. However, this need should not be assumed to be present unless the host government issues a specific request. FLOODS » The need for a surgical response and the factors affecting what types of EMTs would be of greatest value are highly dependent on the cause of the flood, the state of health-care facilities and the rapidity of the flooding.
Injury Types in Conflict[edit | edit source]
injuries inflicted in conflict settings are very different to those encountered in the civilian population but currently there is no international humanitarian trauma registry and data describing the needs of those injured during conflict are inadequate to support the development of humanitarian trauma systems. [1] [2] A key challenge specific to conflict is that they can deliver a steady tide of patients that ebbs and flows based on the situation on the ground.
Blast injuries, including those from bombs, missiles, grenades, mortars, landmines, improvised explosive devices, unexploded ordnance or explosive remnants of war were more common in rural settings (70%) and accounted for 70.1% of overall injuries, followed by gun shot wounds with 22%, which were more common in urban (42.2%) and semi-urban (26.7%) areas. Other mechanisms of injury included blunt trauma (4.1%), assault (3.9%), unspecified penetrating trauma (3.4%) and burns (3.3%) with the largest number of injuries occurring to the extremities (33.5%). Overall the data also highlights that civilians bear a significant burden of morbidity and mortality in conflict zones. Moreover, paediatric patients sustain a substantial proportion of conflict-related injuries, with children accounting for 34.7% of injured patients. [1] The number of children injured is in line with other international research, which shows that children constitute 30% of seriously injured patients requiring surgical intervention in humanitarian hospitals in conflict zones. Between 2011 and 2016, more than a quarter of Syrian barrel bomb victims were children[3], while 40% of patients treated at an MSF Hospital in Syria during a 2017 offensive were under the age of 18 years [4]. The implications of this further highlight the need for rehabilitation services to be adequately resourced with paediatric equipment and for rehabilitation professionals to have some paediatric expertise including some understanding of these types of injuries on children.[5][2]
Implications for Rehabilitation[edit | edit source]
Injuries sustained in conflict and terrorist attacks present unique challenges, which differ from those seen in disasters, and are also rarely experienced in day-to-day practice away from the conflict zones. Working in situations of conflict, it is important to understand what weaponry is commonly used and the typical injury patterns and surgical and rehabilitation implications.
The concept of ballistics and energy transfer plays an important role in understanding tissue damage in conflict zones, with the level of tissue damage dependant on the efficiency of the energy transfer of the missile – whether this be a bullet or blast fragment. [6]You can read more about ballistics and energy transfer in the ICRC and AO Foundation Field Guide ‘Management of Limb Injuries during Disasters and Conflicts.
Knifes / Machete[edit | edit source]
A machete is long knife with a sharp edge, a broad blade and a thick back that may be either curved or straight. Like a knife they are readily available in many homes and is used used as a multipurpose tools used in the farm, home and construction sites are and can be used as a close range weapon within conflict settings. The types of injuries from knives and machetes vary depending on the mode in which they are used (stabbing or cutting), the part of the blade that is used (sharp of dull edge) and whether the injury was accidental or intentional.[7]
Knives and machetes generally cause multiple injuries, which can include streak-like bruises, lacerations, transection of nerves, vessels and tendons, puncture wounds including to organs with long knives and machetes able to cause a through-and-through perforating wound and can be capable of slicing through bone resulting in open fractures, subtotal decapitation and traumatic amputations. Given the multipurpose use of knives and machetes they also carry a night risk for infections following injury, and a possible source of gangrene and tetanus. [7]Lacerations were the most common injury from a machete (51.35%), with the head the most common site (46%), followed closely by the upper extremity (44%) with 19.2% of those tendon injuries in the hand and worst, most commonly seen in someone trying to protect the head from being hit.[7]
Rehabilitation professionals should be aware of the high risk for wound infection, and be aware of the psychological trauma that is commonly associated with this type of injury. Given the high incidence of lacerations to the head, traumatic brain injury should also be considered.[6]
Bullet Wounds[edit | edit source]
Explosive Weapons[edit | edit source]
Chemical, Biological, Nuclear[edit | edit source]
Heading 3 [edit | edit source]
Add your content to this page here!
Resources[edit | edit source]
Management of Limb Injuries during Disasters and Conflicts.
References [edit | edit source]
see adding references tutorial.
- ↑ 1.0 1.1 1.2 Wild H, Stewart BT, LeBoa C, Stave CD, Wren SM. Epidemiology of injuries sustained by civilians and local combatants in contemporary armed conflict: an appeal for a shared trauma registry among humanitarian actors. World journal of surgery. 2020 Jun;44(6):1863-73.
- ↑ 2.0 2.1 Sargent W, Wild H, Mayhew E, Wren SM. Counting the costs of trauma: the need for a new paediatric injury severity score. Lancet child and adolescent health, The. 2021;5(6):391-2.
- ↑ Guha-Sapir D, Schlüter B, Rodriguez-Llanes JM, et al. Patterns of civilian and child deaths due to war-related violence in Syria: a comparative analysis from the Violation Documentation Center dataset, 2011–2016. Lancet Glob Health. 2018;6:e103–e110. doi: 10.1016/S2214-109X(17)30469-2.
- ↑ OKeeffe J, Vernier L, Cramond V, et al. The blast wounded of Raqqa, Syria: observational results from an MSF-supported district hospital. Confl Health. 2019;13:28. doi: 10.1186/s13031-019-0214-0.
- ↑ Ankomah J, Stewart BT, Oppong-Nketia V, et al. Strategic assessment of the availability of pediatric trauma care equipment, technology and supplies in Ghana. J Pediatr Surg. 2015;50:1922–1927. doi: 10.1016/j.jpedsurg.2015.03.047.
- ↑ 6.0 6.1 Lathia C, Skelton P, Clift Z. Early rehabilitation in conflicts and disasters. Handicap International: London, UK. 2020.
- ↑ 7.0 7.1 7.2 Omoke NI, Madubueze CC. Machete injuries as seen in a Nigerian teaching hospital. Injury. 2010 Jan 1;41(1):120-4.
