Paediatric Trauma Management on Deployment

Abstract

There remains a significant paediatric workload through the military hospital in Camp Bastion. In this paper the authors review and discuss particular problems with resuscitation, investigation, anaesthetic and surgical issues in dealing with children suffering from ballistic injuries. Personal experience and recent papers are used for a qualitative analysis of difficult decisions in the management of paediatric ballistic trauma. Key questions are answered in separate paragraphs for each specialty. The information described in this paper should assist any deployed physician deal with paediatric casualties particularly if they are unaccustomed to paediatric patients in their normal practice.

Blast injuries in children: a mixed-methods narrative review

“…Landmines drive debris, footwear and clothing upward between planes of the soft tissues and bone, leading to degloving injuries of the leg, perineum and lower abdominal viscera, as well creating serious potential for soft tissue and bone infection in the remaining limb 33 58. While large bony defects of the lower limb are problematic in children,84 reconstruction with limited shortening (<2 cm) has been associated with good outcomes, with the capability for highly active growth plates to remodel and compensate for this 66 85. However, 75% of new growth occurs in the distal femur and tibia growth plates, with the distal limb most prone to explosive disruption 33…”

“…Debridement and primary skin closure represented the most common procedure, in 35%–100% of studies,23 35 45 47 50 65 68 82 in keeping with shrapnel injuries leading to multiple and frequently contaminated superficial injuries 68 82. Children are likely to do well with thorough debridement, with well-perfused tissues allowing optimal healing and scar formation 66 85…”

“…One of the key challenges is providing sustainable health services in the host country. MTFs may be capable of delivering exceptional paediatric care in the acute phase following blasts, but recovery from morbidity is dependent on long-term rehabilitation85 normally provided by the host country. Not only can this place exceptional strain on local health authorities, but if provisions are not available, the child is likely to undergo a protracted decline 5 85.…”

A short history of Camp Bastion Hospital: part 2—Bastion's catalytic role in advancing combat casualty care

“…Paediatric trauma accounted for almost 15% of all operating theatre cases from May 2006–May 2008,26 and for up to 30% of all critical care bed occupancy, with 25% of all paediatric admissions being <2 years of age 27. There were 112 paediatric admissions to intensive care from April 2011 to April 2012 (45 of them being due to IEDs), accounting for just under 15% of all admissions to ITU (Figure 10).…”

Preparing British Military nurses to deliver nursing care on deployment. An Afghanistan study

“…The DMS Paediatric Anaesthesia and Critical Care Special Interest Group (PACCSIG), provides clinical guidelines, advice and recommendations on equipment and training (Nordmann et al, 2011;Woods et al, 2012). Participants valued the opportunity to undertake paediatric short courses combined with pre-deployment paediatric training and simulation scenarios included in pre-deployment training at HOSPEX.…”