ABC. See Airway, breathing, and circulation

A

AAST Bladder organ injury scoring system, 290

AAST Organ Injury Scale, ureter and, 285

ABCDE approach, 430

ABC. See Airway, breathing, and circulation

Abdomen

closure, DC 1 and, 194 exploration of, 278

fragment wounding and, 59 GSW to, 275

surgical challenges in, 617, 619–621 tertiary survey and, 451

Abdominal compartment syndrome (ACS), 200, 620

Abdominal examination, pregnancy and, ballistic trauma and, 421 Abdominal gunshot wounds (GSWs),

299–338, 300, 475 antibiotics and, 303 bile duct injury and, 317 clinical investigations in, 301 colon injury and, 319 complications in, 321 CT and, 302

DPL and, 302

FAST and, 302, 476, 477 gallbladder injury and, 317 initial management of, 300

tips and pitfalls of, 299–300 intra abdominal esophagus and,

308–309 laparoscopy and, 302

laparotomy and, 303 liver injury in, 314–317 military environment and, 321 nonoperative management of, 321 organ injury in, 306

DC and, 307

mobilization with, 307 special maneuvers and, 307 surgical adjuncts to, 307–308 pack and transfer v. definitive

treatment in, 321 physical examination of, 301 radiographs and, 301 rectum and, 319–320 small bowel injury and, 318 spleen injury and, 317–318 stomas in, 321

surgery and, 303 incision for, 305

prepping and draping for, 304 temporary abdominal closure and,

321 tetanus and, 303 wounds and, 303 Abdominal injury

children and, 409–410 Lebanese civil war and, 587 NGOs field hospitals and, 549,

555–559 pediatric, 410

DPL and, 409 hematuria and, 410 incisions and, 409–424 shock and, 410

Abdominal vascular injury scale, 332

Index

627

ABIs. See Ankle brachial indices Abscesses

colon injury and, 319

penetrating renal injuries and, 283 Accountability, human rights violations

and, 131 Acidosis

abdomen and, 617 DC and, 186–187 ICU and, 453

Acinetobacter, PHIs and, 340 ACS. See Abdominal compartment

syndrome

Activated protein C, ICU and, 462 Acute renal failure, ICU and, 461–462 Acute respiratory distress syndrome

(ARDS) ICU and, 457–458, 462 risks for, 457

stress wave and, 52 thoracic wounds and, 243 Acute tubular necrosis, 461

Administration, prehospital care and, 149

Adrenal organ injury scale, 333 Advanced Life Support Group

(ALSG), Major Incident Medical Management and Support Course and, 140 Advanced Life Support

Group/Battlefield Advanced Trauma Life Support (ALSG/BATLS) initial medical care and, 430 PHIs and, 332

spinal cord injury and, 349 Advanced Trauma Life Support

(ATLS), 489, 492, 494, 499 abdominal GSWs and, 300 ballistic trauma and, 486 burn injury and, 424 ICU and, 449

lateral chest injury and, 614 military perspective on, 490–491 penetration injury and, 446 P-hold and, 532

Sarajevo siege and, 574 surgeons and, 488–489 thoracic wounds and, 246

Advanced Trauma Life

Support/Battlefield Advanced Trauma Life Support

(ATLS/BATLS), 142 resuscitation and, 152 spinal cord injury and, 354 Africa

case study education in, ballistic injury and, 594–595 gun-related deaths in, 10 Aide Memoire, 146 Airway

anesthesia and, 164–165 burns and, 426, 430

airway edema in, 426 control

collars and, 153–155 simple procedures and, 153 neck and, 213–214

Airway, breathing, and circulation (ABC), 142, 148

assessment of, 144

austere conditions and, 592 limb injury and, 360–361

Airway obstruction, trauma death and, 243

AK-74 assault rifles, 42, 84

bullets from, body armor and, 88 gun-related deaths and, 10 ALSG/BATLS. See Advanced Life

Support Group/Battlefield Advanced Trauma Life Support

ALSG. See Advanced Life Support Group

Altered ammunition, 39 American Gator Mines, 61 American pump gun, 38 Ammunition

altered, 39

forensic aspects of, 94–95 pistol v. rifle, 39–40 small arms and, 4

Amputation. See also Below-knee amputations; Knee joint;

Surgical debridement;

Wound(s)

austere environments and, 583

blast injury and, 55–56

Lebanese civil war and, 586 limb injury and, 362–363 mines and, 62

pediatrics and, 583, 584 vascular injury and, 390 wound surgery and, 552, 554 Anaerobic metabolism, ICU and, 454 Analgesia, burns and, 432

Anastomosis, 386 femoral artery and, 387 NGO environment and, 560 Sarajevo and, 573

ureter repair and, 287 Anesthesia

ballistic casualty and, 151–167 early phase presentation for, 161 late phase presentation for, 162 NGOs field hospital and, 549 operating theater, problems in,

164–167 planning, 162–164

resuscitative endpoints and, 164 Anesthetists, austere environments

and, 582

Angiographic embolization, liver injury and, 316

Angiography

chest injury and, 472 DC 1 and, 193 liver injury and, 316 missiles emboli and, 254 neck injury and, 218–219 PHI and, 333, 334, 335 trauma patient and, 308 Angled contact wounds, 100 Angle of yaw

bullet and, 96 tissue density and, 97

Animal studies, blast injury and, 52 Ankle brachial indices (ABIs), GSWs

and, 480

Antacids, spinal cord injury and, 352 Anterior sternocleidomastoid (SCM),

232 incision

children and, 404

esophageal injury and, 233, 234 neck injury and, 226, 227

tracheolaryngeal wounds and, 235

Anterograde flow, carotid artery injuries and, 228

Anteroposterior (AP) of chest, ballistic injury and, 465

Anteroposterior (AP) radiograph, chest injury and, 472 Antibiotics

abdominal GSWs and, 303 burn injury and, 441, 442

children and, head trauma in, 401, 402 lateral chest injury and, 616

NGOs field hospital and, 548–549 PHIs and, 340

spinal cord injury and, 352 Antipersonnel mines

genitourinary injury and, 272 injury from, 63

Ottawa Convention and, 45 Aortic arch, 210, 211

API. See Doppler Artery Pressure Index

Aprotinin, liver trauma and, 166 AP. See Anteroposterior of chest ARDS. See Acute respiratory distress

syndrome

Arginine, trauma patients and, 461 Armed

conflict, wounded in, 513 violence, 130

reporting of, 126 WHO and, 124, 125 Armor. See also Armor systems;

Combat body armor; Personal armor

personal armor and, 68 plate, BABT and, 86 stab, 82

textile, 74

bullet energy and, 74 Armor systems

manufacturers of, 86 projectile defeat and, 74 Arm, upper, injuries of, 373–374 Arterial

blood flow, ballistic injury and, 381 emboli, 254

injury, 383

operative management of, 384–390

spasm, child v. adult with, 413

Arterial bleeding, children and, head trauma in, 399, 402

Arterial lines, 187–188

Arteriography, vascular injury and, 383 Aspartate aminotransferase (AST), 55 Assault rifle round, 39, 40

AST. See Aspartate aminotransferase ATLS. See Advanced Trauma Life

Support

Atypical entrance wounds, 98, 107–109.

See also Entrance wounds Auditory system

blast and, 53

blast injury and, 53–54 Austere conditions

ABC and, 592 amputation and, 583 ballistic injury and, 585–591 bottled mineral water and, 580 emergency care and, 586 hemorrhagic shock and, 581 patient self management and, 590 surgeon in, 580–583

transfer and, 593 Automatic weapon, 36, 37

Autonomic dysreflexia, spinal cord injury and, 353

AVPU Score, 144

Axillary artery injury, surgery for, 390–391

B

BABT. See Behind armor blunt trauma Baer Hugger, hypovolemic shock and,

186 Ballistic

protection

coverage of, 69–70 mechanics of, 68–69 threats and testing of, 71 textiles, 74

trauma, 122–124 ATLS and, 490 burn injury in, 424–443 children and, 396–414

epidemiological background of, 396–397

crime scene and, 145–146 CT imaging and, 466

humanity and, 131–132 intensive care role in, 596–605 management training for, 486–

510 MRI and, 466

public health and, armed violence results and, 124–127

wound markers and, 466 Ballistic injury

arterial system and, 381 austere environments and, 585–

591

bleeding and, preoperative control of, 384

cervical collars and, 153–155 children and, 397–398

epidemiology of, 397–398 prehospital care in, 398–399 resuscitation in, 398–399 external fixation and, 372–373 hand and, 374–375

imaging tools for, 481 imaging triage for, 465–481 Johannesburg General Hospital

Approach and, 499 lessons learned in, Africa and,

592–593

limbs and, radiographs and, 377–

378

long-term consequences of, 573 military environment of, surgical

procedures and, 178 organic psychiatric problems and,

602 PHIs and, 343

pregnancy and, 418–423 assessment and management

during, 419

related web site addresses for, 508–509

retained fragments and, 378 Sarajevo siege and, 569–575 specific organ injury and, 308–320 spinal cord injury and, 348 surgical boundaries and, 308 survivors of, psychology of, 602 through-and through injury and,

622

treatment overview for, 360

Ballistics, 94 PHI and, 326

Ballistic trauma training

management of, surgeon competence in, 500

Balloon tamponade, vertebral artery and, 232

Barotrauma, 458

Basic Life Support first aid, burn injury and, 429

BASICS website, prehospital environment and, 139 Battlefield

explosive force and, introduction of, 45–46

killing and, 600

Lines of Care in, 535–536 Victims of War and, 589–590 Battlefield Advanced Trauma Life

Support (BATLS), 150, 490, 491

Behind armor blunt trauma (BABT), 49, 84–87

Below-knee amputations, 554 Benzylpenicillin, burn injury and, 442 Bicortical pin placement, external

fixation and, 372–373 Bile duct injury, 317

Biliary injuries, extrahepatic, 317 Bladder, 287, 288, 289

abdominal GSWs and, 320 NGO environment and, 559 penetrating injuries to

associated injuries and, 290 classification of, 290 clinical diagnosis of, 289 imaging of, 290

laboratory diagnosis of, 290 management of, 291

outcome and complications of, 291 Bladder injury scale, 334

Bladder organ injury scoring system.

See AAST Bladder organ injury scoring system Blast injury, 95

animal studies and, 52 auditory system and, 53–54 solid organ injury with, 55 Blast lung, burn injury and, 427

Blast wave. See Dynamic overpressure Bleeding. See also Hemorrhage

liver injury and, 316

preoperative control of, 383–384 thoracic great vessel injuries and, 255 vertebral artery and, 232–233 Blood

bank, DC-Ground Zero and, 188 Lebanese civil war and, 588 samples, analysis and, 113 stomach injury and, 310

transfusions, NGOs field hospital and, 549

Blood-brain barrier, pulmonary contusions and, 187

Blood pressure, abdominal GSWs and, 300

Blood urea nitrogen (BUN), CS and, 174

Blunt injury, 611–626 misdiagnosis and, 613 penetrating trauma v., 612 prehospital care in, 611

prehospital information and, 612 tertiary survey and, 452

Body armor. See Combat body armor Bomblet, fragmentation injury and, 56,

57, 58 Bombs, 45

Bone(s). See also Fractures; Injuries;

Trauma exit wounds and, 106 fractures, KE and, 96 grafting, 374

wound excision and, 172 Bony injury

First Line of Care and, 535 limb injury with, 365 Bore number, 36

Bottled mineral water, austere environments and, 580 Bouncing Betty. See Bounding mines Bounding mines (bouncing betty), 60 Bowel injury, NGOs field hospital and,

549

Brachial artery, vascular injury and, 390 Brain-injury. See also Head-injury

trauma and, 161

Brazil, gun-related deaths and, 11

Breathing burns and, 431 chest injury and, 157 neck and, 214

Breath sounds, ICU and, 446 Britain, firearms in, death rates from,

9–10

British anti-Lewisite (BAL), Lewisite toxicity and, 443

Bronchoscopy

tracheobronchial injuries and, 258–259

VAP and, 458

Bullet(s). See also Ammunition;

Explosives; Hollow point rifle bullets; Rifle(s); Shotguns AK-47 rifle, 42

angle of yaw and, 96 assault rifle, 39, 40

atypical entrance wounds and, 107 BABT and, 85

ballistic protection, 71 deformation of, 97 drag force and, 97 effects of, 40–41 energy, armors and, 74 forensics and, 94 full metal jacket, 40 gunshot evidence and, 115 handgun round, 40 high-energy, BABT and, 84 jacketed hollow point, 40 KE and, 40–41, 96

knife protection v., test standards for, 81

M-6A1 rifle, 43 M-16, 85

mechanism of injury with, 42–44 pistol v. rifle, 39

rubber, 40 soft point, 40

trajectory, aerodigestive injury and, 216

Bullet wounds

abdominal GSWs and, 301 characteristics of, 43 BUN. See Blood urea nitrogen Burn(s), 424–443. See also Airway;

Escharotomy

airway and, 155–157 assessment of, 439 clingfilm and, 429 cutaneous

epidermal burns and, 427

%TBSAB and, 427

definitive care transfer for, 436 EBWs and, 49

epidemiology of, 424–425 escharotomies and, 439 first aid for, 429 full thickness, 435, 436 infection in, 441–442 inhalation injury in, 426, 438

airway burn and, 426 lung injury and, 426 systemic toxicity and, 427 initial medical care in, 430 managing, 428–429

mass casualty scenarios and, 443 monitoring, 435

NGO environment and, 561, 563 partial thickness, 428

deep dermal, 428 full thickness, 428 superficial dermal, 428 pathophysiology of, 425 personal armor and, 67

principle of definitive care in, 437 referral criteria for, 436

SIRS and, 441 special, 442–443 systemic injury in, 426 thermal, 442

transfer preparation in, 436–437 vesicant, 442

wound and, 435–436 wound healing in, 441 Burn management

burn size and, 432 inhalation injury and, 432 Burn shock, 434

Burr hole, penetrating head injury and, 560–561

C

CAB. See Catastrophic hemorrhage,

airway, and breathing

Calf, fasciotomy of, 176–177

Capsular laceration, pancreas injury and, 313

Carbines, history of, 32, 35, 36

Carbon monoxide, burn injury and, 427 Carboxyhemoglobin levels, burns and,

432 Cardiac

bleeding, 253 injury, 252–254 ischemia, 165

monitoring, ICU and, 450 tamponade, 252

clinical manifestations of, 244–245

thoracic wounds and, 244–245 Cardiopulmonary bypass, 253

Cardiopulmonary resuscitation (CPR), bullet wound and, 623 Cardiovascular system, pregnancy and,

419

Care Under Fire, non-permissive environment and, 137 Carotid artery

injuries

repair of, 230–232

trauma management and, 228–233 neurologic examination and, 214–215 operative anatomy of, 211

shunts, 389 injuries and, 230

vascular injury and, 391–392 Cartridge, 31, 36

cases, gunshot evidence and, 115 Cartridge-discharge residue (CDR),

94

Case study, DGE and, 606–607 Casualty

armor removal and, 87–88 fault-line wars and, 542 gun-related deaths and, 11–14 transfer, NGO field hospital and,

563–564 triage and, 532

Casualty Reduction Analysis model, armor and, 72

Catastrophic hemorrhage, airway, and breathing (CAB), 142 Catheters. See also Fogarty catheters;

Foley catheter

intraventricular, 335 IV, ICU and, 447

spinal cord injury and, 353 CBA. See Combat body armor CBC. See Complete blood count CBD. See Common bile duct CCA. See Common carotid arteries CDC. See Centers for Disease Control Centers for Disease Control (CDC),

gun-related deaths and, 9 Central America, gun-related deaths

and, 10–11

Central lung injury. See Injuries Central nervous system (CNS), blast

injury and, 55

Central spinal fluid (CSF) fistula, 342 PHIs and, 343

Central venous pressure (CVP), anesthesia and, 164 Cephalosporin, burn injury and, 442 Ceramic plate. See Rigid ceramic

plate

Cerebral angiogram, carotid artery injuries and, 229

Cerebral edema, children and, 400 Cerebral perfusion pressure (CPP),

PHI and, 337

Cerebral spinal fluid (CSF), PHI and, 341

Cervical collars

ballistic injury and, 153–155 ICU and, 446

Cervical spine

immobilization, penetrating neck injury and, 215–216 non-permissive environment and,

142

penetrating trauma and, 143 Cervical stab injury, children and, 402 Cervical vascular organ injury scale,

324 Cesarean section

ballistic injury and, 422 post-mortem, 422

CFD. See Color flow Doppler CG. See Computer-generated training

environment Chain of Care

evacuation and, 144–145

Chain of Care (cont.) hospital and, 145 transfer and, 145

Chain of custody, gunshot and, 116 Chemical warfare agents, burns and,

442 Chest drainage

chest tube insertion and, 249 children and, 404

sizes by age for, 405 Chest injury

AP radiograph and, 472 chest retractors and, 617, 618 chest tube and, 614

thoracotomy and, 251–252

Chest retractors, chest injury and, 617, 618

Chest tube

lateral chest injury and, 614, 616 thoracic wounds and, 248–249 Chest wall injury scale, 325 Children. See also Ballistic injury,

children

abdominal injury in, 409–410 ballistic trauma in, 396–414 burn injury and, 426 chest drain in, 404

insertion technique for, 404 clam shell incision and, 408 definitive thoracotomy and, 408 DPL and, 409

firearms damage and, 8–9 head injury in, 399–402 median sternotomy and, 422 methylprednisolone and, 403 midline incision in, 411 neck incisions in, 403–404 neck injury in, 402–404

penetrating injury, weapons and patterns of, 397–398 peripheral vascular injury in, 411 prehospital care with, 399–402 resuscitation with, 399–402 resuscitative thoracotomy and, 408 RT and, 406–407

spinal cord injury and, 403 thoracic injury in, 404 thoracoscopy in, 406 X-ray and, 404–406

Chip fracture, 365 Chloramphenicol

head trauma and, 561

NGOs field hospital and, 548, 549 Choking, 36

Cholecystojejunostomy, bile duct injury and, 317

Cholesteatoma, blast injury and, 53 Circulation, 149

anesthesia and, 165–166 burns and, 431

injured patient and, 157–160 Civilian injury

military injury v., 359–360 PHI and, 343

weapon use and, framework application for, 127–128 Civilian medical practice, missiles

emboli and, 254

Clam shell incision, children and, 408 Class characteristics, 115

Clingfilm, 435

burn injury and, 429 Closed-cell polymeric foam, 77 Close-range wounds, 101, 272 Clothing handling

gunshot evidence and, 114 intermediate range wounds and,

104 Clotting cascade, 187

CNS. See Central nervous system Coagulopathy

abdomen and, 617, 619, 620 austere environments and, 581 ICU and, 454

trauma patient and, 187–188 Code of Conduct, 20

Collar incision, tracheolaryngeal wounds and, 235

Colloid resuscitation, ICU and, 449 Colon

injury

abdominal GSWs and, 319 NGO environment and, 559, 560 penetrating renal injuries and,

282–283

repair, penetrating abdominal

wounds and, 573, 574

Colon injury scale, 331

Color flow Doppler (CFD), neck injury and, 221

Columbia, gun-related deaths and, 11 Combat

genital injuries and, 291–293 killing and, 601

Combat body armor (CBA), 69. See also Helmets, ballistic; Knife protection; Protective armor bullet perforation and, 88

deformation of, 86 Kevlar, 85

law-enforcement agencies and, BABT and, 86

lightweight flexible, police and, 86 medical issues with, casualty

numbers and, 83–84 police and, 79, 80

police v. military, 79, 80, 81 removal of, 87–88

torso and, 81–83 toxicities and, 59 UK’s, 79

Combat Casualty Evacuation Care, 137 permissive environment, 138

Combat helmets. See Helmets, ballistic

Comminuted fracture, 365

Common bile duct (CBD), duodenum injury and, 311

Common carotid arteries (CCA), 210 Compartment syndrome, 175–177

wound surgery and, 551

Complete blood count (CBC), PHIs and, 332

Complex fracture, Sarafix and, 573 Compressive stress wave, 51 Computed tomography (CT)

abdominal GSWs and, 302, 476 ballistic trauma and, 465, 466 chest, entrance wound and, 474 children and, 406

head trauma in, 400, 402 diaphragm injuries and, 480 GSW on, 332, 471

ICU and, 447

intestinal injury and, 55 lateral chest injury and, 616 neck injury and, 209, 468–471

penetrating renal injuries and, 274, 283

PHIs and, 326, 333, 334, 335, 336, 344 pregnant abdomen and, 421

spinal cord injury and, 350 tertiary survey and, 199–200 thoracic wounds and, 248 transcervical GSWs and, 217, 218 transmediastinal injuries and,

472–475

Computed tomography angiography (CTA), neck injury and, 220–221

Computer-generated (CG) training environment, 498

Conoid fracture, bullet and, 76 Constriction, 36

Contact wounds, 107

entrance wounds and, 98–101 Contamination

DC 1 and, 193–194

trauma laparotomy and, 306 war surgery and, 558 war wounds and, 60, 168

Continuous Positive Airway Pressures (CPAP), 53

Continuous veno-venous hemodialysis (CVVH), ICU and, 461 Contrast enhanced CT scan, ballistic

abdominal trauma and, 477–480

Contrast esophagography, esophageal perforation and, 474 Copper sulfate, burns and, 442 CPAP. See Continuous Positive Airway

Pressures

CPP. See Cerebral perfusion pressure CPR. See Cardiopulmonary

resuscitation

Craniocerebral injuries. See Cushing and Matson’s classification of craniocerebral injuries Craniotomies, Lebanese civil war and,

587

Cricothyroidotomy, airway and, 156 Crime scene, 145–146

Critical Incident Stress Debriefing, 604

Cruciform entrance wound, 99

Crush syndrome (CS), 175–176 laboratory findings in, 175 Crystalloid penicillin, 433, 434

NGOs field hospital and, 549 CSF. See Cerebral spinal fluid CS. See Crush syndrome

CTA. See Computed tomography angiography

CT. See Computed tomography (CT) Cushing and Matson’s classification of

craniocerebral injuries, 328 Cutting diathermy, burns and, 440 CVP. See Central venous pressure CVVH. See Continuous veno-venous

hemodialysis Cyanides, burn injury and, 427 Cystogram, bladder, 292

Cystography, bladder injury and, 290

D

Dacron patch, carotid artery injuries and, 230

DALYs. See Disability-adjusted life years

Damage control (DC), 624 abdomen and, 617, 620

abdominal closure and, 194, 195 abdominal GSWs and, 307 acidosis and, 186–187 coagulopathy and, 187–188 ECG and, 189

essential equipment for, 189 hemorrhage and, 190–193 hypothermia and, 185–186 ICU and, 447

incisions, 190

initial laparotomy and, 189–197 NGOs field hospital and, 548 orthopaedics, 204

surgical bleeding and, 197

trauma, system applications and, 205 trauma and, 160

Damage control (DC)-Ground Zero, prehospital setting and, 188 Damage control (DC) II

Factor VII and, 198–199 ICU resuscitation and, 197–198 tertiary survey and, 199–200 unplanned reoperation and, 200–201

Damage control (DC) III abdominal closure and, 202–203 definitive reconstruction, 201–204 delayed fascial closure and, 203–204 Damage control (DC) pathway,

triggers used for, 185

Damage control (DC) surgery, 180–208 history of, 181–184

pathophysiology for, 184–185 patient selection for, key factors for,

184

three phase approach to, 182, 183 DC. See Damage control

Deadly triad, reversing, 453

Death, soldiers experience of, 599–601 Debridement. See Surgical

debridement

Deep neck space, operative anatomy of, 212

Deep vein thrombosis (DVT) ICU and, 450

spinal cord injury and, 353 Default transport, 145

Definitive burn care, 451. See also Burn(s)

Definitive care, trauma practitioner and, 495

Definitive reconstruction, DC III and, 201–204

Definitive Surgical Trauma Care (DSTC) course, 495–496, 500, 624

core curriculum for, 504–508 principles for, 614

Definitive thoracotomy, children and, 408

Delayed primary closure, wound surgery and, 551 Desmopressin, ICU and, 454 Detonator, 46

Diagnosis, delayed, 624 Diagnostic equipment

hospital and, 520–521 NGOs field hospital and, 548 thoracic wounds and, 247–248 Diagnostic laryngoscopy (DL),

tracheobronchoscopy and, 225 Diagnostic peritoneal lavage (DPL)

abdominal GSWs and, 302

blast injury and, 55 children and, 409 Diaphragm injury, 262–263

CT and, 480 incidence of, 309 management of, 310 NGO environment and, 559 Diaphragm injury scale, 327

Diazepam, Lebanese civil war and, 586 DIC. See Disseminated intravascular

coagulation

Digital probing, lateral chest injury and, 616

Digital rectal examination (DRE) colon injury and, 319

lesson learned from, 606–607 Directional fragmentation mines, 61 Disability

burns and, 431 trauma and, 160–161

Disability-adjusted life years (DALYs), deaths and, 6

Disappearances, reporting framework for, 128–131

Disseminated intravascular coagulation (DIC), 165, 188, 342

Distal duodenal mobilization, small bowel injury and, 318 Distance-range wounds, 104–105

shotgun entrance, satellite pellet wounds and, 111

Divot fracture, 365, 367

DL. See Diagnostic laryngoscopy Documentation

forensic evaluation and, 92, 93 GSWs and, 93

intermediate range wounds and, 103

Doppler fetoscopy, 421

hand-held, GSWs and, 480 studies, vascular injury and, 383 Doppler Artery Pressure Index (API),

vascular injury and, 411 DPL. See Diagnostic peritoneal lavage Drag force, bullet and, 97

Drain removal, chest tube insertion and, 249

Draping, GSWs and, 304

DRE. See Digital rectal examination Dressings, burns and, 442, 561 Drill-hole fracture, 365, 367 Drugs. See also Specific drugs i.e.

Penicillin

prehospital care and, 149

DSTC. See Definitive Surgical Trauma Care course

Duodenum injury, 311 NGO environment and, 559 Duodenum injury scale, 330 Dural sinus, PHIs and, 338 DVT. See Deep vein thrombosis Dynamic overpressure, 46

EBW mechanism and, 49 enhanced, 49

E

EBWs. See Enhanced-blast weapons ECA. See External carotid artery ECG. See Electrocardiograph Echelons of care. See Lines of Care Echocardiography, children and, 406 Economic Community of West-African

States (ECOWAS), 20 ECOWAS. See Economic Community

of West-African States Elbow joint, fractures of, 373 Electrocardiograph (ECG)

anesthesia and, 163 DC and, 189

Elemental analysis, GSWs and, 104 Elevated lactate dehydrogenase

(LDH), 55 Eley cartridge, 38

Emboli, limb injury and, 624, 625 Embolization, liver injury and, 316 Emergency care, austere environments

and, 586

Emergency medical service (EMS) DC-Ground Zero and, 188 PHIs and, 330

trauma resuscitation and, 492, 493 Emergency room (ER)

clothing and, gunshot wound and, 114

firearms morbidity and, 6

forensic medicine and, 91

imaging and, 467

Emergency room thoracotomy (ERT), 249–251

chest injury and, 616 OR thoracotomy v., 614

Endemic diseases, NGOs field hospital and, 544

Endotracheal tube airway and, 154 ICU and, 446 ventilation and, 165

Endovascular stents, neck trauma and, 233

Energy. See also Kinetic energy explosions and, 46

missiles and, 69 personal armor and, 67

Enhanced-blast weapons (EBWs), 47–51

combined injury and, 64–65 currently used, 48

thermal blasts and, 56

Enterotomies, small bowel injury and, 318

Entrance wounds, contact wounds and, 98–101

Environment

ballistic casualties and, 161

ballistic missile injuries and, 569, 570 explosives in, burns and, 431 killing and, 600

Environmental debris, fragment wounding and, 59 EOD equipment. See Explosive

ordinance disposal equipment ER. See Emergency Room

ERT. See Emergency room thoracotomy Escharotomy

burn injury and, 435, 437 lines of election for, 440 Esophagography

esophagoscopy v., 223–224 neck injury and, 223–224 Esophagoscopy

esophageal injuries and, 261 esophagography v., 223–224 neck injury and, 223–224 Esophagus, 308–309

evaluation, neck injury and, 222–224

injury, 260–262

management of, 233–234 perforation, contrast

esophagography and, 474 wounds, pharyngeal wounds v., 234 Esophagus injury scale, 330

Europe, firearms in, death rates from, 9–10

Evacuation

Chain of Care and, 144–145 front line and, surgery near, 588 hospital, Iraq conflict and, 597 spinal cord injury and, 354 Evaluation, injury-prevention model

and, 21–23 Evidence, 112

chain of custody and, 116 explosives and, 116 informational, 112 physical, 112–113

Excretory urogram, penetrating renal injuries and, 274

Expert witness, GSWs and, 93 Explosions, 46–47

Explosive force, 31

battlefield and, introduction of, 45–46 Explosive ordinance disposal (EOD)

equipment, 65

bomb disposal suits and, 80–81 personal armor and, 68 removal of, 87

Explosives

evidence and, 116 small arms and, 4

Exposure/Environment, burns and, 431

Extension of task, 148

External carotid artery (ECA), 210 External fixation

ballistic injury and, 378 fractures and, 372, 379 technique of, 372–373

External splints, fractures and, 369 Extrahepatic bile ducts, NGO

environment and, 558 Extrahepatic biliary tree injury scale,

329

Extraliminal balloon tamponade,

bleeding and, 384

Extremity gunshot wounds (GSWs), ABIs and, 480

Eyes. See also Ocular injury blast injury and, 54

F Face

GSW to, surgical challenges of, 621 injury

mine blast and, 562

NGO environment and, 561 Facial compartments

compartment syndrome and, 175 wound surgery and, 551

Fact-based interventions, injury- prevention model and, 3–4 FAE. See Fuel-air explosive bombs Fallopian tube injury scale, 335 Fascial closure

definitive reconstruction and, 201–204

delayed, 203–204 Fasciotomy

calf, 176–177

compartment syndrome and, 176 foot, 177

forearm and, 374 Sarajevo siege and, 572 thigh, 176

vascular injury and, 388, 389 wound management, 177 FAST. See Focused abdominal

sonogram for trauma Fault-line wars, casualty figures from,

542

Fecal Occult Blood Test, pelvic injury and, 606

Femoral artery graft repair of, 385

vascular injury and, 390–391 Femoral fractures, 356, 357, 358, 369,

371 Femoral vessels

groin and, 577 injury, 576–577

Fetal injury, penetrating maternal trauma and, 414–415 Fetus, ballistic injury and, 420 FFPs. See Fresh frozen platelets

Fibrin glue, liver injury and, 316 Field intensive care facilities

DRE and, 606 Iraq conflict and, 596

Field surgical teams (FSTs), war surgery and, 537

Finger fracture, liver injury and, 316 Firearm-discharge residue (FDR), 94 Firearms, 31. See also Rifle(s); Shotguns

Canada exports and, 15 civilian, 5

civilian possession of, 19 death rate, Canada v. US in, 24 economic impacts of, 7–8 forensic aspects of, 94–95 health and, 7

history of, 31

injury, forensic evaluation with, 92 mechanism of injury with, 41–44

bullet effects in, 42–44 resources on, 23–24 rights arguments and, 16–17 social and environmental costs of, 7 working mechanics of, 31–40 Fireball (flash)

EBW mechanism and, 48 injury with, 56

Fistulas

abdominal GSWs and, 321 colon injury and, 319

Flaccid paralysis, spinal shock and, 350 Flash. See Fireball

Flechets, 58

Flexion deformities, Sarajevo siege and, 573

Flucloxacillin, burn injury and, 442 Fluid replacement therapy, burn injury

and, 561 Fluids

burn injury and, 438 burns and, 434–435, 442

hypotensive resuscitation and, 159 Fluothane, Lebanese civil war and,

586

Focused abdominal sonogram for trauma (FAST), 64 abdominal GSWs and, 302, 476 Fogarty catheters, arterial injury and,

384

Foley catheter, 384–385 penile injuries and, 292 Foot

fasciotomy of, 177 fractures and, 376–377 GSW and, 377

Forearm, surgical debridement and, 374 Foreign materials, wound surgery and,

551 Forensic

ballistic laboratories, test firing and, 103

evaluation

firearm injury and, 92 gunshot victim and, 118 evidence, gunshot and, 112 medicine, 91

evaluation in, 92 terminology, 94

Formal bypass graft, carotid artery injuries and, 230, 231 Forward surgical teams (FSTs), 497,

537

structure of, personnel, 537 war surgery and, 537, 538 Fractures

ballistic, nonoperative management of, 378

bony injury with, 365, 366, 367–373 complete v. incomplete, 365 drill-hole, 367

elbow joint, 373

external fixation and, 372 forearm injury and, 374 hand injury and, 374 IM fixation and, 370 incomplete divit, 368

limb injuries and, 356, 357, 358 lower limb injury and, 375

foot and, 376–377 lower leg, 375–376 thigh and, 375–376 multifragmentary, 367

NGOs field hospital and, 554–555 Sarajevo siege and, 572

secondary management of, 378–379 external fixation and, 379 joint involvement and, 379 plaster and, 378

simple, 366 stabilization of, 368

external splints and, 369 internal fixation and, 370 intramedullary fixation and, 370 plaster and, 369

traction and, 369–370 upper limb injury and, 374 Fragmentation injury, 56–60

military v. civilian, 95

Fragmentation weapons, 50, 56–60 Fragments

personal armor and, 68

retained, ballistic injury and, 378 Fragment wounding

bacterial contamination and, 60 environmental debris and, 59 Fresh frozen platelets (FFPs), ICU

and, 454

Friedlander Relationship, blast wave and, 46–47

Front line, surgery near, 588 FSTs. See Forward surgical teams or

Field surgical teams Fuel-air explosive (FAE) bombs, 47,

56

EBW mechanism and, 48 Full metal jacket, 39

Fulminate of Mercury, potassium chlorate and, 46

G

Gallbladder injury, 317 Gastrogaffin, 474

Gastrointestinal (GI) tract, blast injury and, 54

GCS score. See Glasgow Coma Scale score

Gelfoam, DC and, 193 Gelignite, 46

General Medical Council (GMC), UK, ballistic injury and, 91 Geneva Convention, weapons and, 17 Genital injury, 291–293

clinical findings of, 292 management of, 292–293 mines and, 272–273

outcome and complications of, 293

radiological findings of, 292

Genitourinary system SGW and, 270 stab wounds and, 270

Gentamicin, burn injury and, 442 GI tract. See Gastrointestinal tract Glasgow Coma Scale (GCS) score,

335

PHIs and, 333, 343, 344 trauma and, 144

Glutamine, trauma patients and, 461 Glycemic control, ICU and, 457 Grenade launchers, fragmentation

injury and, 56 Grief, 604

Groin, vascular injuries in, 576–578 Ground brief, 147

GSR testing, 113

GSWs. See Gunshot wounds

Guidelines of Penetrating Head Injury, PHI and, 341

Guidelines to Penetrating Brain Injuries, 343

Guillotine amputation, wound surgery and, 552

Gulf War

abdominal wounds and, 299 hemorrhage and, 158 training exercises and, 152 wounds in, 360

Gum-elastic bougie, 154 Gun control legislation, 22 Gun-free zones, 21 Gun-owner registration, 23 Gunpowder, 31

Gun-related deaths, causal factors of, 11–14

Gunshot

injury, challenges of, 614 pellets, 110

victims

deceased, 115–116 evidence and, 112–113 wound descriptions and, 117 Gunshot residue (GSR), 94 Gunshot wounds (GSWs). See also

Extremity gunshot wounds;

Hepatic gunshot wounds;

Injuries; Transmediastinal gunshot wounds; Wound(s);

Specific type i.e. Abdominal gunshot wounds

abdominal, 300, 475 Africa case study and, 595 appearances of

entrance wounds and, 98–104 exit wounds and, 105–106 forensic terminology and, 98–112 characteristics of, 110

children and

head trauma in, 399, 402 peripheral vascular injury in, 411 classification of, 110

cranial, prognostic outcome in, 402 CT after, 471

CT of, 339

documentation and, 93 DRE and, 606

face and, 154 femur and, 375 foot and, 377

forensic concepts and, 94 forensic evaluation and, 92 humerus and, 358

kinetic energy transfer, 95 pediatric, 411

penetrating, 98

penetrating renal injuries and, 282 perforating, 98

rectum and, failure to evaluate, 620

thoracic great vessel injuries and, 255–257

tracheolaryngeal wounds and, 234–235

undiagnosed, 623 ureter repair, 287 Gun violence, civilian, 299

H

Haemophilus influenza, VAP and, 458

Haifa hospital, war surgery and, 589, 590

Handgun Epidemic Lowering Plan (HELP), 23

Handgun round, 39

Handguns, murders with, 22

Hard-contact wounds, 96, 99

Head

surgeon challenges and, 621–623 wounding missiles and, 70 Head-injury. See also Vietnam Head

Injury Study children and, 399–402 NGO environment and, 560 trauma and, 160

Health-care system

organizations, firearms and, 23 personnel, pre-deployment and, 579 system assessment

epidemiology and, 515 funding, 515

healthcare access and, 515 human resources and, 515 logistics and, 515

prehospital care and, 514 security and, 515

surgery in, structure location for, 515

system structure and, 514 weapon wounded and, 513–516 Hearing loss, blast injury and, 53–54 Heart, pledgets suturing and, 594 Heart injury scale, 325–326

Heart murmur, cardiac injury and, 253 Heat lamps, hypovolemic shock and,

186

Helical CT scans, 261

Helicopter landing site (HLS), Chain of Care and, 145

Helmets, ballistic, 77, 78–79 bullets and, 68

patterns of, 77

penetrating missiles and, 69 personal armor and, 76 removal of, trauma and, 88 HELP. See Handgun Epidemic

Lowering Plan Hematocrit/hemoglobin (H/H),

CS and, 174 Hematuria

pediatric abdominal injury and, 410 penetrating renal injuries and, 273 penetrating ureteral injuries and, 284 Hemi-amputation, pediatrics and, 583 Hemodynamic stability, DC surgery

and, 181

Hemodynamic status, penetrating renal injuries and, 273

Hemorrhage. See also Massive hemorrhage; Subarachnoid hemorrhage

abdominal GSWs and, 321 compressible, 158

DC and, 190–193, 204–205 DC surgery and, 181 First Line of care and, 535 injured patient and, 157–160 neck and, 214

noncompressible, 158

non-permissive environment and, 142

pericardium and, 252 PHIs and, 338

preoperative control of, 384 trauma laparotomy and, 305 Hemorrhagic shock, austere

environments and, 581 Hemostatic agents, topical, liver injury

and, 316

Hemothorax, VATS and, 252 Heparin, 400. See also Intermittent

subcutaneous (SQ) heparin arterial injury and, 384

Hepatic artery ligation, liver injury and, 316

Hepatic gunshot wounds (GSWs), contrast enhanced CT scan, 477–480

Hepatic tractotomy, liver injury and, 316

HE. See High explosives

H/H. See Hematocrit/hemoglobin High energy transfer gunshot wounds

(GSWs)

children and, abdominal injury in, 409–410

vascular injury and, 381 wound excision for, 553 High explosives (HE), 46

blast injury and, 46, 48

High velocity missiles, wounds and, 60 High velocity projectiles, 270

misconceptions about, 95 HIV. See Human immunodeficiency

virus

HLS. See Helicopter landing site Hollow point rifle bullets, 97 Homicide, 6

Horizontal spray mines, 61

Hospital. See also Nongovernmental organizations; Postoperative care; Prehospital care;

Prehospital environment care, CS and, 175

Chain of Care and, 145 clinical services in, 524

consumable supplies in, 521–522 equipment in, 520–521

medical, 520–521 non-medical, 521 expertise in, 522

finance and funding for, 524–252 front line and, 588

infrastructure of, 519 buildings around, 519–520 electricity and, 520 maintenance in, 520 medical, 519

sewage and sanitation in, 520 waste disposal in, 520 water and, 520 medical staff in, 523–524 NGO and, 543–545 nursing staff in, 523–524 protection of, 517–519 resource-limited situations in,

525–526 security of, 517–519

system assessment and, 513–526 Hospital assessment, individual,

516–525. See also Health-care system

Hospital supplies. See Supplies, hospital

HSD. See Hypertonic saline dextran Human immunodeficiency virus (HIV),

firearms damage and, 8 Humanitarian law, 122–124 Humanity, ballistic trauma and,

131–132 Human rights abusers, 19 Humerus, fractures and, 371 Hydralazine, spinal cord injury and,

353

Hydrocephalus, postsurgical complications and, 342 Hyperbaric oxygen, inhalation injury

and, 439

Hyperchloremic acidosis, 434–435 Hyperglycemia, acute renal failure and,

461–462

Hyperkalemia, cardiac arrhythmia and, 174

Hypertension, penetrating renal injuries and, 283

Hypertonic saline dextran (HSD), 159 Hyperventilation, ICP and, 337 Hypotension

abdominal GSWs and, 300 differential diagnosis of, 165–166 maternal, 420

Hypotensive resuscitation, 159–160 anesthesia and, 163

fluids and, 159

transfusion protocols and, 160 Hypothermia

abdomen and, 617 ballistic casualties and, 161 DC and, 185–186

ICU and, 455 Iraq conflict and, 596 Hypovolemia

burn injury and, 561 ICU and, 449

Hypovolemic shock, 186

I

IAP. See Intra-abdominal pressure IATSIC. See International Association

for Trauma and Surgical Intensive Care

ICP. See Increased cranial pressure ICRC. See International Committee of

Red Cross ICU. See Intensive care unit Imaging. See also Computed

tomography; Magnetic resonance imaging;

Neuroimaging; Radiographs abdominal injury and, 475

battlefield conditions and, 481

craniofacial injuries and, 467–468

neck injury and, 468–471

Imaging. (cont.) prehospital, 481

transmediastinal injuries and, 472–475

IM fixation. See Intramedullary fixation Impalement injury, 260

Inceptor Body Armor, 49 Incision(s)

chest injury and, 617, 618 DC and, 190

longitudinal, extremity wounds and, 550

oblique iliac fossa, inguinal ligament and, 576, 578

RT and, 406–407

thoracic access and, children and, 407–408

transverse, neck injury and, 227 vertical, groin and, 577

Incomplete contact wounds, 101 Increased cranial pressure (ICP)

intraventricular catheters and, 335 PHI and, 335

Infants, post-mortem cesarean section and, 422

Infection(s). See also Contamination;

Sepsis; Septic shock 1st Line of Care and, 536 austere conditions and, 590 blood stream, ICU and, 459 ICU and, 457

PHIs and, 340, 341 pin tract, 571, 572 presurgical care and, 168 Sarajevo siege and, 571 spinal cord injury and, 353 Inferior mesenteric vessels, NGO

environment and, 560 Inferior vena cava (IVC)

liver injury, 315–316 pregnancy and, 420

Inguinal ligament, oblique iliac fossa incision and, 576, 578 Inhalation injury, 432

airway edema and, 438–439 burns and, 438, 442 Initial laparotomy

DC part 1 and, 189–197 preparation for, 189

Injuries. See also Abdominal injury;

Blast injury; Blunt injury;

Burn(s); Civilian injury;

Genital injury; Limb injury;

Liver injury; Overpressure;

Primary blast injury; Soft tissue injury; Spinal cord injury; Spleen injury;

Stomach injury; Thoracic;

Thoracoabdominal injuries;

Ureteral injury; Vascular injury; Specific organ injury i.e. Ocular injury

ballistic

clinician role in, 91–92 forensic aspects of, 91–118

central lung, hilum clamping and, 250 classification of, by mechanism, 50 combined, 64–65

fetal, penetrating maternal trauma and, 414–415

impalement, 260

land mines and, patterns of, 62 lower limb, 64, 623

ocular, mines and, 62 scrotal, 292

shotgun, 177–178

small bowel, abdominal GSWs and, 318

solid organ, blast injury with, 55 spine, tertiary survey and, 452 subclavian vascular, 256 thoracic duct, 263

thoracoabdominal, 262–263 Injury classification, PHI and, 327 Injury-prevention model

EBW mechanism and, 48 evaluation and, 21–23

fact-based interventions and, 3 Instability, spinal cord injury and, 350 Intensive care

Iraqi patients and, 597

role of, ballistic trauma and, 596–605 trauma patient in, ballistic injuries

in, 445–463 Intensive care unit (ICU)

acute renal failure in, 461–462 arrival in, penetration injury and,

445–447

blood stream infections in, 459 coagulopathy and, 454 contemporary issues for, 457 daily maintenance in, 449–450 deadly triad and, 453

DM in, 453 ERT and, 251

esophageal injuries and, 617 hyperglycemia and, 461–462 hypothermia, 455

missed injuries in, tertiary survey and, 451

nutrition in, 460–461 open abdomen and, 455–456 OR and, 456

resuscitation, DC II and, 197–198 team, penetration injury and, 446 travel from, 462

Intermediate range wounds, powder tattooing and, 102

Intermittent positive-pressure

ventilation (IPPV), anesthesia and, 164–165

Intermittent subcutaneous (SQ) heparin, ICU and, 450 Internal carotid artery, vascular injury

and, 389 Internal fixation

fractures and, 370, 371 plates, 373

Internal jugular vein (IJV), 210 NGO environment and, 561 SCM and, 227–228

International Association for Trauma and Surgical Intensive Care (IATSIC), 489, 495, 496

International Committee of Red Cross (ICRC), 498

antipersonnel mines and, 46 firearms deaths and, 6 framework questions and, 128 hospital protection and, 518–519 Lebanese civil war and, 589 NGOs and, 543

Sarajevo siege and, 575

surgical courses with, Sarajevo siege and, 575

wound classification of, 379

International Committee of Red Cross (ICRC) hospital, 545

surgical procedures in, 547 International Crime Victimization

Survey, 5

International Federation of Red Cross.

See Red Cross International humanitarian law,

hospital protection and, 517–518

International law, rights arguments and, 17

International Red Cross Organization.

See International Committee of Red Cross

International relief aid, firearms damage and, 8

Interventional radiology (IR), neck injury and, 209

Interventions, small arms trade and, 18–21

Intestinal system. See Gastrointestinal tract

Intra-abdominal abscess, 311 Intra-abdominal esophagus

abdominal GSWs and, 308–309 injury of

incidence of, 308–309 management of, 309

Intra-abdominal organ injuries, war surgery and, 557

Intra-abdominal pressure (IAP), monitoring of, 200–201 Intracerebral hematoma, 338

Intracranial pressure, children and, 400 Intramedullary (IM) fixation, fractures

and, 370, 371

Intramedullary (IM) nailing, 373 fractures and, 370, 371 Intraperitoneal colon, NGO

environment and, 559 Intrathoracic injuries, war surgery and,

557

Intravascular shunts, DC and, 192 Intravenous (IV) catheters, ICU and,

447

Intravenous (IV) fluids ICU and, 447

prophylactic, burns and, 434–435

Intravenous pyelogram (IVP),

penetrating renal injuries and, 274

Intraventricular catheters, ICP and, 335 Intraventricular hematoma, 338 Investigations, lateral chest injury and,

614

Ioban, abdominal closure and, 194 IPPV. See Intermittent positive-

pressure ventilation Iraq

conflict, field intensive care facilities and, 596

patients, intensive care and, 597 transfer team repatriation in, 597 IR. See Interventional radiology Ischemia

arterial blood flow and, 381–382 hypovolemic shock and, 186 vascular injury and, 382 Isotonic crystalloid, ICU and, 449 Israeli-Lebanese conflict, PHI and, 326 IVC injuries. See Juxtahepatic inferior

vena cava injuries IVC. See Inferior vena cava IVP. See Intravenous pyelogram IV. See Intravenous

J

Jacketed hollow point, 39 Japan, firearms in, 16

Johannesburg General Hospital ballistic injury and, 499

trauma unit in, African education in, 594–595

Joints, fractures and, 379

Juxtahepatic inferior vena cava (IVC) injuries, 314

K

KE. See Kinetic energy Ketamine

anesthesia maintenance and, 163 Lebanese civil war and, 586 Kevlar soft-body armor. See also

Combat body armor BABT and, 85

vests and, 21

KIA. See Killed in Action

Kidney

abdominal GSWs and, 320 GSWs and, 270

NGO environment and, 559 rhinorrhaphy and, 279 SGW and, 270 Kidney injury scale, 333 Killed in Action (KIA), wound

distribution of, 69, 70 Killing, battlefield, 600 Kinetic energy (KE)

bullets and, 40–41 density, 76 PHI and, 326 transfer

factors determining, 95–98 gunshot wound and, 95 transfer variables, 98

Knee joint, amputation and, 552 Knife protection (armors), 82, 83

bullets v., test standards for, 81 Knives, 67

torso armor and, 81–83 Kocherization of duodenum, 311 Korean War, PHI and, 326

L

Laboratory

findings, CS and, 175

samples, gunshot evidence and, 113 Lactated Ringer’s (LR) solution, ICU

and, 449

Lactate levels, ICU and, 449 Land mines, 60–64

Laparoscopy, abdominal GSWs and, 302

Laparotomy, 524

abdominal GSWs and, 301, 303, 475 austere environments and, 581, 582 DM and, 620

DRE and, 606

NGO environment and, 560 postoperative management and, 320 ureter and, 285

war surgery and, 557 Laparotomy packs, 307 spleen injury and, 317

Laryngotracheal evaluation, neck

injury and, 224–225

Laryngotracheal injury

endotracheal approach in, 225 physical examination in, 225 Lateral chest injury

management of, 614 trauma surgeon and, 614

Law-enforcement agencies, body armor and, BABT and, 86

LDH. See Elevated lactate dehydrogenase

Lebanese civil war, war surgery during, 585–591

Left visceral rotation, 279 Lethal triad, 180

Level One trauma center, 496 urban, 497

Light weapons, 4 Limb injury

amputation and, 362–363

bony injury with, 365, 366, 367–373 challenges in, 623–639

lower, 623

previous wars and, 571 resuscitation for, 360–361 surgery for, 361

technique in, 361–362 tourniquets and, 364 treatment overview for, 360 upper, 373–375

wound closure and, 364 wound surgery on, 550 Limb wounds, 356 Lines of Care

1st Line and, 536 infection and, 536 2nd Line and, 536 3rd Line and, 536 battlefield and, 535–536 Liver injury, 314–317

hepatic artery ligation and, 316 hepatic tractotomy and, 316 ICRC hospital and, 559–560 management of, 314–315

angiography and, 316 embolization and, 316 fibrin glue, 316 finger fracture in, 316

hepatic artery ligation and, 316 inflow occlusion in, 315

mobilization in, 315 perihepatic packing in, 315 track tamponade and, 316 vena cava control in, 315–316 NGO environment and, 558 Liver injury scale, 328 Liver packing, 307

Liver tampon, DC and, 193 Liver trauma, aprotinin and, 166 Loose-contact wounds, 100, 101 Lower limb injury. See Injuries Low-velocity handgun, thoracic injury

and, 614

Low velocity projectiles, 272 Lund and Browder chart, %TBSAB

and, 434 Lung injury scale, 326 Lungs

airway burn and, 426 blast injury to, 51, 53 DC and, 204–205

injuries of, hilum clamping and, 250

M

M-6A1 rifle, 43

M18A1 Claymore AP munition mine, 61

M79 grenade launcher, retained ordinance and, 65 Machine guns, 36, 37 Magazine, shotguns and, 36 Magnetic resonance angiography

(MRA), neck injury and, 221–222

Magnetic resonance imaging (MRI) ballistic trauma and, 466

PHI and, 335

spinal cord injury and, 350

Major Incident Management training, 150

Major Incident Medical Management and Support Course (MIMMS), 493 ALSG and, 140

Malnutrition, Sarajevo siege and, 569 MAP. See Mean arterial pressure Massacres, reporting framework for,

128–131

Massive hemorrhage, mortality and, 180

Massive hemothorax, thoracic wounds and, 246

Massive transfusion, protocols, 160 MCP joints, fractures and, 374 Mean arterial pressure (MAP), blast

and, 53

Mechanical ventilation, nosocomial pneumonia and, 458–459 Median sternotomy, children and, 408 Mediastinal sepsis, intra abdominal

esophagus injury and, 309 Medical equipment. See also

Diagnostic equipment DC and, 189

prehospital environment and, 140 Medical orders, 524

Medical treatment facility (MTF), triage and, 529, 530, 531, 532 Mental disorders, post traumatic,

variables in, 602–605 Mental health

postcombat outcomes and, 602–605 survivors and, 602

Metallized explosives, 47 burns and, 442 Methane report, 141 Methylprednisolone children and, 403

spinal cord injury and, 352 METI human patient simulator, 492 Mexico, firearms in, 15

Microscopic examination, GSWs and, 104

Military environment abdominal GSWs and, 321 ballistic injury and, surgical

procedures and, 178 PHI and, 325

Military first responder, 494–495 Military helmets. See Helmets, ballistic Military injury, civilian injury v.,

359–360

Military personnel, wounding missiles and, 70

MIMMS. See Major Incident Medical Management and Support Course

Mines, genitalia and, 272–273

Ministry of Health, hospital assessment and, 515

Missiles

non-penetrating, 69 penetrating

energy and, 69 personal armor and, 67 stopping, 69

Missiles emboli, 254

Missile wounds, distribution of, 586 Missing people, reporting framework

for, 128–131 MIST system, 498

MLRS. See Multiple Launch Rocket Systems

MODS. See Multiple-organ dysfunction syndrome

Morbidity

bladder injury and, 291 blast injury and, 54 firearms and, 6

pancreas injury and, 313 Mortality

abdominal GSWs and, 300 bladder injury and, 290 blast injury and, 54 DC surgery and, 182 duodenum injury and, 311 esophageal injury and, 262 firearms and, 6

GSWs and, 13 larynx and, 224

liver injury and, 316, 317 massive hemorrhage and, 180 pancreas injury and, 313 PHI and, 343

thoracic wounds and, 242–243 MRA. See Magnetic resonance

angiography

Multiple Launch Rocket Systems (MLRS), 61

Multiple-organ dysfunction syndrome (MODS), 458

ICU and, 459

Multisystem injury, triage and, 66 Muscle, wound excision and, 171–172 Muscle group injury, wound surgery

on, 550–551

Musculoskeletal system, blast injury and, 55–56

Musculoskeletal trauma, vascular procedure and, 389 Myelography, spinal cord injury and,

350

Myocardial ischemia, hypothermia and, 455

N

Nasogastric feeding, burn injury and, 438

Nasogastric tube burn injury and, 437 spinal cord injury and, 353 National Rifle Association, firearm

regulation and, 19

National Trauma Management Course (NTMC), 489, 490

NATO. See North Atlantic Treaty Organization

Near contact wounds, 101 Neck

airway and, 213–214 anatomy of, 210–213 assessment of, 213–218 breathing and, 214 DC and, 205 gunshot in, 156 hemorrhage and, 214 knife injury and, 155 spinal cord injury and, 354 surgeon challenges of, 621–623 zone 1 injury of, 226

zone III injury of, 228 zone II injury of, 226–228 zones of, 212, 213, 391, 392

penetrating injury and, 468, 469 Neck trauma, 209–240

angiography and, 218–219 carotid artery and, 228–233 CFD and, 221

children and, 402–404 CTA and, 220–221

endovascular stents and, 233 esophagography and, 223–224 esophagoscopy, 223–224 history of, 209–210 investigation of, 216

laryngotracheal evaluation, 224–225 mortality, 210

NGO environment and, 560, 561 operative approaches to, 225–226 penetrating, 209

physical examination and, 219 trajectory determination and,

216–218

vascular examination and, 218 Nephrectomy

nonoperative management and, 276, 277

penetrating renal injuries and, 273 Nerves, wound excision and, 172 Neurogenic shock, 350

Neuroimaging, PHI and, 333, 334, 335 Neurological function, vascular injury

and, 382–383 Neurologic examination

neck and, 214

spinal cord injury and, 349 Neurologic status, spinal cord injury

and, 354

New England Journal of Medicine, murder rates comparison and, 12

NGOs. See Nongovernmental organizations

NIBP. See Noninvasive blood pressure Nitrous oxide, Lebanese civil war and,

586

Nongovernmental organizations (NGOs), 18–19, 20, 512 ballistic injury management in,

541–564

hospital assessment and, 515 hospital environment in, 543 refugee camp surgery and, 585 Nongovernmental organizations

(NGOs) field hospital abdominal injury and, 555–559 anesthesia, 549

antibiotics and, 548–549 casualty transfer and, 563–564 DC in, 548

diagnostic equipment in, 548 endemic diseases and, 544 environment in, 543

extremity fractures and, 554–555

Nongovernmental organizations (NGOs) field hospital (cont.) OR in, 544

patient characteristics in, 545 penetrating wounds in, 548–549 postoperative care and, 563–564 prehospital care in, 545

surgery in, 545

surgical management in, 550–563 amputations and, 552, 554 wound surgery and, 550–552 triage in, 546–547

vascular injury and, 554–555 Noninvasive blood pressure (NIBP),

anesthesia and, 163 Non-permissive environment,

treatment in, 142

No-reflow phenomenon, vascular injury and, 382

North America, firearms damage and, 9 North American Trauma Center study,

ERT and, 251

North Atlantic Treaty Organization (NATO), 73

BABT and, 87 PHI and, 327

spinal cord injury and, 354 war surgery and, 537 Nosocomial pneumonia, 458

mechanical ventilation and, 458–459 NTMC. See National Trauma

Management Course Nursing care, 524

spinal cord injury and, 353 Nutrition

ICU and, 360–361

pin tract infection and, Sarajevo siege and, 571, 572

O

OAS. See Organization of American States

Oblique iliac fossa incision, inguinal ligament and, 576, 578 Ocular injury, NGO environment and,

561, 562 Open abdomen

ICU and, 455–456 management of, 455–456

Open pneumothorax, thoracic wounds and, 245–245

Operating room (OR) DC surgery and, 182 NGOs field hospital, 544

Operating room (OR) thoracotomy, ERT v., 614

Operating theater, 524 Operational analysis tools, 73

Operation Just Cause, wounds and, 60 Operative dressing, wound surgery

and, 551

Oral fluid therapy, mass casualty scenarios and, 443 Orders process, 147

Organic psychiatric problems, ballistic injury and, 602

Organization for Security and Cooperation in Europe, 20 Organization of American States

(OAS), 20 Organ repair

definitive reconstruction and, 201–204

war surgery and, 558 OR. See Operating room Orthopedic(s)

DC and, 204 injury

Lebanese civil war and, 587 tertiary survey and, 452 Osteotomy, vascular injury, 392 Ottawa Convention, antipersonnel

mines and, 45 Ovary injury scale, 322

Overpressure, thoracic injury and, 51

Oximetry, burn injury and, 435 Oxygen-carrying blood substitutes,

NGOs field hospital and, 549

Oxygen saturation, burn injury and, 427

P

Packaging, prehospital care and, 149

Packed red blood cells, ICU and, 449

Packing, vertebral artery and, 232

PAC. See Pulmonary artery catheter

Pain

ICU and, 449

spinal cord injury and, 354 Palestinian refugee camp, surgery in,

585–591 Pancreas injury, 312–314

contusion in, 313 management of, 312, 313 NGO environment and, 559 Pancreas injury scale, 329

Pancreatectomy, pancreas injury and, 313

Paralysis, ICU and, 450

Partial nephrectomy, technique of, 282 Partial thromboplastin time (PTT),

187

Pathologist, forensic, trauma personnel and, 91

Patient self management, austere conditions and, 590 PBO. See Poly Cp-phenylene-2,6-

benzobisotazole

Pediatrics, austere environments and, 583

PEEP. See Positive end expiratory pressure

Pellet colic, 272 Pelvic fracture

austere environments and, 581, 582 high riding prostate and, 607 Pelvic gunshot, peritonitis and, 621 Pelvic injury, DRE and, 606 Penetrating abdominal wounds,

Hospital Sarajevo, 573 Penetrating chest injury

CT and, 475

Lebanese civil war and, 587 management of, 264

Penetrating genitourinary trauma, mechanisms of, 270–273 Penetrating head injuries (PHIs),

325–347 CT of, 350 EMS and, 330

GCS score and, 333, 343 injury classification in, 327–328 postoperative care for, 341–342 preoperative treatment for, 335–340 prognosis for, 342–344

resuscitation in, 330

surgical management of, 340–341 Penetrating injury, 215–216

cervical spine and, 143

misguided information and, 613 Penetrating limb injuries, 596 Penetrating renal injuries, 272–282

associated injuries to, 282–283 clinical findings in, 273 complications from, 283 diagnosis of, 273

kidney organ injury scoring system and, 275

laboratory findings in, 273 nonoperative management of,

274–277

operative management of, 278–282 outcomes from, 283

radiological findings in, 274–275 Penetrating trauma, 614

blunt injury v., 612

tracheal compression and, 155 Penetrating ureteral injuries, 283–284

associated injury with, 284 clinical findings in, 284 Penetrating wounds, 330, 331

Africa case study and, 594 anatomical distribution of, 539 groin and, 576–578

Penicillin, NGOs field hospital and, 548

Penile injuries, surgery and, 292 Penis, amputated, reimplantation of,

293

Penis injury scale, 337

Penrose drain, genital injuries and, 293 Pepper pot wounds, Lebanese civil war

and, 589

%TBSAB. See Percentage total body surface area burned Percentage total body surface area

burned (%TBSAB) burn injury and, 426, 429, 437 Lund and Browder chart for, 434 mass casualty scenarios and, 443 rule of nines for, 433

Perforating wounds, 98, 330, 332 Perforation, delayed, blast injury and,

54