Better be prepared: the spectrum of neuropsychiatric impairment among Libyan war victims transferred to Germany for trauma rehabilitation

Background The current Libyan civil war has originated many casualties, imposing medical challenges. War injuries are complex, requiring specialized knowledge and interdisciplinary assessment for adequate patient and intercultural management. Methods This retrospective study analyzed records of 78 Libyan patients admitted from July 2016 to November 2017 to neurological and trauma surgical departments of Krankenhaus Nordwest, Frankfurt, Germany. Issues of system preparation of the hospital, demographics, injury patterns and therapies were analyzed. The chi-squared test was used to analyze differences in injury patterns in explosion and gunshot injuries. Results Seventy-seven of seventy-eight patients were male (mean age 30.6 years). The patients received primary and secondary treatment in Tunisia (n = 39), Libya (n = 36) and Turkey (n = 23). Forty-eight patients had gunshot injuries, 37 explosion injuries, 11 both. Preparation for management of injuries included hygienic and isolation protocols, organization of interpreters and intercultural training. Patients presented with a broad variety of neurological, psychiatric and trauma surgical injuries. Fifty-six patients had sensory, 47 motor deficits. Nine reported headache, 5 vertigo, 13 visual impairment, 28 psychiatric symptoms. Eighteen patients had central nervous damage, 50 peripheral nervous damage. Central nervous damage was significantly more common in gunshot than explosion injuries (p = 0.015). Peripheral nervous damage was more common in explosion than gunshot injuries (p < 0.1). Fifty-one patients had polytrauma and 49 suffered from fractures. Therapy included surgical interventions (n = 56) and physiotherapy. Structured rehabilitation programs were often indicated. Conclusion Specialized knowledge about war injuries and their management including hospital preparation and planning regarding infrastructure may be required anytime. Injuries include a broad variety of neurological, psychiatric and trauma surgical injuries. Therefore, an interdisciplinary approach is crucial.

GENITOURINARY INJURIES DURING WAR AGAINST TERROR: A SINGLE-CENTER EXPERIENCE

Objective: To compare our experience of genitourinary injuries during the war against terrorism with the record of those in previous wars of the World. Study Design: Cross sectional study. Place and Duration of Study: Urology department, Combined Military Hospital Peshawar, from Jun 2011 to Aug 2014. Methodology: We treated 89 (5.6%) cases of genitourinary injuries received in our tertiary care hospital in Khyber Pakhtunkhwa. The hospital was located at a distance of 2-3 hours of evacuation time by helicopter from the forward operational area. Results: The frequency of genitourinary injuries among 1589 war casualties was (5.6%). Out of these 49 (55%) were due to sniper shots and 40 (45%) due to improvised explosive device. Kidney was the most common organ injured 30 (33.7%), followed by bladder 20 (22.5%) and urethra 14 (15.7%). Majority of renal and bladder injuries were afflicted in those soldiers who were not wearing the protective jackets. Associated injuries to other organs were identified in 81% cases. Salvage of all genitourinary organs was the aim; however, nephrectomy and orchiectomy had to be performed in 30% and 50% respectively. Conclusion: Salvage of genitourinary war injuries poses a challenge to the trauma surgeon as lifesaving measures take precedence over organ preservation. Renal trauma in war was found to be the leading critical genitourinary injury.

Traum'cast: an online, open-access educational video podcast series for teaching military trauma care to all healthcare providers

The aim of this paper was to describe the development of ‘Traum’cast’, an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum’cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum’cast is an educational innovation that meets a public health requirement.

Application of Treatment Simulation Software for War Injury in Emergency Treatment Training on the Battlefield based on Chinese Visible Human Datasets

Background: Proficiency in self-help and mutual aid skills is correlated with the prognosis of injured patients, and this study aims to create treatment simulation software for war injuries that reflect the physical constitution of Chinese people and study its application in first aid training on the battlefield. Methods: Based on thin-sectional, highly precise Chinese Visible Human (CVH) data with high resolution, combined with self-help and mutual medical aid measures such as digital pressure hemostasis, cricothyroid membrane puncture, pneumothorax puncture and bone marrow puncture for battlefield first aid, useing Amira and other softwares to building the simulation software for the technical training of military medical students and basic medical officers was constructed. Eighty medical service students were trained on battlefield first aid technology, and a new training mode for the treatment of war injuries was developed and optimized. Results: Simulation software of hemostasis and puncture for battlefield first aid that was suitable for the technical training of military medical students and its supporting teaching materials 3D-PDF were established. The software included modules of hemostasis of the vertex, face, head-shoulder, shoulder-arm, forearm, upper forearm, lower limb and foot and puncture of the cricothyroid membrane , pneumothorax, and bone marrow cavity. Collaborating with interactive 3D-PDF, it was successfully used for on-site first aid training of military medical students. The questionnaire results showed that the trainees had a high recognition of the human-computer interactive performance of the software with a clear interface and easy operation. The accuracy and richness of the three-dimensional model structure, knowledge of hemostasis and puncture and applied anatomy contained in this software were high, helping trainees to quickly master the knowledge points and operation techniques related to hemostasis and puncture. Conclusion: The system can effectively mobilize the learning enthusiasm of students and fully improve the learning efficiency of the basic materials and applied anatomy of battlefield first aid, as well as the teaching efficiency of teachers. The training simulation of battlefield first aid, comprising a combination of various modes, effectively complemented each other, met many training needs, and achieved satisfactory training results. Additionally, this software could be used in the emergency training of traffic accident injuries and disaster-related injuries.

Gunshot Injuries of the Maxillofacial Region

The current principles and pillars in the management of gunshot maxillofacial injuries have largely been the result of an exhaustive experimental approach spanning centuries of warfare. However, while medical professionals endlessly strive to revolutionize healthcare in combat injury, there are simultaneous efforts directed towards creation of new and ever more lethal arms and ammunition. Consequently, these doctrines continue to undergo significant transformations with a contemporary understanding of war injuries as well as the advent of new surgical materials and modern instrumentation. Previously accepted principles like external pin fixations without adequate exposure of bony fragments, fracture stabilization using intra-osseous wiring and inter-maxillary fixation, minimal attention to primary soft tissue closure and delay in definitive management have been sidelined for most of the part. On the other hand, new principles have evolved that including adequate exposure of fracture fragments and precise anatomic rigid fixation, immediate bone grafting, definitive soft tissue management and early definitive repair allowing for better return of patients to their pre-traumatic appearance.

Role of Cancer Surgery in the Improvement of the Operative Skills of Military Surgeons During Deployment: A Single-Center Study

ABSTRACT Introduction The maintenance of military surgeons’ operative skills is challenging. Different and specific training strategies have been implemented in this context; however, little has been evaluated with regard to their effectiveness. Cancer surgery is a part of military surgeons’ activities in their home hospitals. This study aimed to assess the role of oncological surgery in the improvement of military surgeons’ operative skills. Methods Between January and June 2019, the surgical activities of the departments of visceral, ear, nose, and throat, urological, and thoracic surgery were retrospectively reviewed and assessed in terms of the operative time (OT). All surgeons working at the Sainte Anne Military Teaching Hospital were sent a survey to rate on a 5-point scale the current surgical practices on their usefulness in improving surgical skills required for treating war injuries during deployment (primary endpoint) and to compare on a 10-point visual analog scale the influence of cancer surgery and specific training on surgical fluency (secondary endpoint). Results Over the study period, 2,571 hours of OT was analyzed. Oncological surgery represented 52.5% of the surgical activity and almost 1,350 hours of cumulative OT. Considering the primary endpoint, the mean rating allocated to cancer surgery was 4.53 ± 0.84, which was not statistically different than that allocated to trauma surgery (4.42 ± 1.02, P = 0.98) but higher than other surgery (2.47 ± 1.00, P &lt; 0.001). Considering the secondary endpoint, cancer surgery was rated higher than specific training by all surgeons, without statistically significant difference (positive mean score of + 2.00; 95% IC: 0.85–3.14). Conclusion This study demonstrates the usefulness of cancer surgery in improving the operative skills of military surgeons.