Recent progress in surgery for the victims of disaster, terrorism, and war—Introduction

Medical Management of Disasters and Mass Casualties From Terrorist Bombings: How Can We Cope?

“…1,2,9,35,47 In contrast to The Journal of TRAUMA Injury, Infection, and Critical Care normal practice, casualties must be kept out of hospitals to the greatest extent possible. The time of greatest danger to orderly casualty handling, and of risk of hospital overload, is in the immediate aftermath of a bombing, a period of chaos.…”

“…This emphasizes the importance of a short interval between injury and treatment, and early aggressive resuscitation, as a prognostic factor for survival. 1,32 The high immediate death rate (68%), and the high dead/wounded ratio of Ͼ 2:1 (which is a reversal of the 1:2-1:5 ratio typical of military combat in conventional wars) was probably because of the extreme magnitude of the explosive force and the added impact of building collapse. Both of these are major prognostic factors of terrorist bombings that affect casualty outcome.…”

“…It is the only reliable means by which continuity of care can be maintained and redundant triage and treatment can be avoided as patients are transported through the successive echelons of care mandated in mass casualty scenarios. 1 These records should be strapped to the patient to avoid being lost. Plastic lamination has been suggested to protect against moisture.…”

“…However, triage must assume great importance in mass casualty scenarios in which the large numbers of casualties overwhelm existing medical resources. 1 The challenge of triage in this setting is to identify that minority of casualties who are critically injured and require immediate care, from among the great majority of casualties who are not critically injured. The greater the number of casualties, the more difficult this becomes, the more time it may take to find those needing immediate care, and the greater the likelihood of preventable deaths caused by delay in treatment of the most severely injured.…”

Surgery and Refugee Populations

“…Large numbers of injuries, the breakdown of communication systems and infrastructure, and the need for external assistance characterize the emergent phase. Much of the surgical literature relating to refugee care has concentrated on this time period and utilizes many of the principles developed in conflicts such as World War II, Korea, and Vietnam (32). Key elements of this phase include triage and careo fa cute and chronic surgical conditions.…”