Index

A laparotomy and, 303 AAST Bladder organ injury scoring liver injury in, 314–317 system, 290 military environment and, 321 AAST Organ Injury Scale, ureter and, nonoperative management of, 321 285 organ injury in, 306 ABCDE approach, 430 DC and, 307 ABC. See Airway, breathing, and mobilization with, 307 circulation special maneuvers and, 307 Abdomen surgical adjuncts to, 307–308 closure, DC 1 and, 194 pack and transfer v. definitive exploration of, 278 treatment in, 321 fragment wounding and, 59 physical examination of, 301 GSW to, 275 radiographs and, 301 surgical challenges in, 617, 619–621 rectum and, 319–320 tertiary survey and, 451 small bowel injury and, 318 Abdominal compartment syndrome spleen injury and, 317–318 (ACS), 200, 620 stomas in, 321 Abdominal examination, pregnancy surgery and, 303 and, ballistic trauma and, 421 incision for, 305 Abdominal gunshot wounds (GSWs), prepping and draping for, 304 299–338, 300, 475 temporary abdominal closure and, antibiotics and, 303 321 bile duct injury and, 317 tetanus and, 303 clinical investigations in, 301 wounds and, 303 colon injury and, 319 Abdominal injury complications in, 321 children and, 409–410 CT and, 302 Lebanese civil war and, 587 DPL and, 302 NGOs field hospitals and, 549, FAST and, 302, 476, 477 555–559 gallbladder injury and, 317 pediatric, 410 initial management of, 300 DPL and, 409 tips and pitfalls of, 299–300 hematuria and, 410 intra abdominal esophagus and, incisions and, 409–424 308–309 shock and, 410 laparoscopy and, 302 Abdominal vascular injury scale, 332

627 628 Index

ABIs. See Ankle brachial indices Advanced Trauma Life Abscesses Support/Battlefield Advanced colon injury and, 319 Trauma Life Support penetrating renal injuries and, 283 (ATLS/BATLS), 142 Accountability, human rights violations resuscitation and, 152 and, 131 spinal cord injury and, 354 Acidosis Africa abdomen and, 617 case study education in, ballistic DC and, 186–187 injury and, 594–595 ICU and, 453 gun-related deaths in, 10 Acinetobacter, PHIs and, 340 Aide Memoire, 146 ACS. See Abdominal compartment Airway syndrome anesthesia and, 164–165 Activated protein C, ICU and, 462 burns and, 426, 430 Acute renal failure, ICU and, 461–462 airway edema in, 426 Acute respiratory distress syndrome control (ARDS) collars and, 153–155 ICU and, 457–458, 462 simple procedures and, 153 risks for, 457 neck and, 213–214 stress wave and, 52 Airway, breathing, and circulation thoracic wounds and, 243 (ABC), 142, 148 Acute tubular necrosis, 461 assessment of, 144 Administration, prehospital care and, austere conditions and, 592 149 limb injury and, 360–361 Adrenal organ injury scale, 333 Airway obstruction, trauma death and, Advanced Life Support Group 243 (ALSG), Major Incident AK-74 assault rifles, 42, 84 Medical Management and bullets from, body armor and, 88 Support Course and, 140 gun-related deaths and, 10 Advanced Life Support ALSG/BATLS. See Advanced Life Group/Battlefield Advanced Support Group/Battlefield Trauma Life Support Advanced Trauma Life (ALSG/BATLS) Support initial medical care and, 430 ALSG. See Advanced Life Support PHIs and, 332 Group spinal cord injury and, 349 Altered ammunition, 39 Advanced Trauma Life Support American Gator Mines, 61 (ATLS), 489, 492, 494, 499 American pump gun, 38 abdominal GSWs and, 300 Ammunition ballistic trauma and, 486 altered, 39 burn injury and, 424 forensic aspects of, 94–95 ICU and, 449 pistol v. rifle, 39–40 lateral chest injury and, 614 small arms and, 4 military perspective on, 490–491 Amputation. See also Below-knee penetration injury and, 446 amputations; Knee joint; P-hold and, 532 Surgical debridement; Sarajevo siege and, 574 Wound(s) surgeons and, 488–489 austere environments and, 583 thoracic wounds and, 246 blast injury and, 55–56 Index 629

Lebanese civil war and, 586 Anterograde flow, carotid artery limb injury and, 362–363 injuries and, 228 mines and, 62 Anteroposterior (AP) of chest, ballistic pediatrics and, 583, 584 injury and, 465 vascular injury and, 390 Anteroposterior (AP) radiograph, wound surgery and, 552, 554 chest injury and, 472 Anaerobic metabolism, ICU and, 454 Antibiotics Analgesia, burns and, 432 abdominal GSWs and, 303 Anastomosis, 386 burn injury and, 441, 442 femoral artery and, 387 children and, head trauma in, 401, 402 NGO environment and, 560 lateral chest injury and, 616 Sarajevo and, 573 NGOs field hospital and, 548–549 ureter repair and, 287 PHIs and, 340 Anesthesia spinal cord injury and, 352 ballistic casualty and, 151–167 Antipersonnel mines early phase presentation for, 161 genitourinary injury and, 272 late phase presentation for, 162 injury from, 63 NGOs field hospital and, 549 Ottawa Convention and, 45 operating theater, problems in, Aortic arch, 210, 211 164–167 API. See Doppler Artery Pressure planning, 162–164 Index resuscitative endpoints and, 164 Aprotinin, liver trauma and, 166 Anesthetists, austere environments AP. See Anteroposterior of chest and, 582 ARDS. See Acute respiratory distress Angiographic embolization, liver injury syndrome and, 316 Arginine, trauma patients and, 461 Angiography Armed chest injury and, 472 conflict, wounded in, 513 DC 1 and, 193 violence, 130 liver injury and, 316 reporting of, 126 missiles emboli and, 254 WHO and, 124, 125 neck injury and, 218–219 Armor. See also Armor systems; PHI and, 333, 334, 335 Combat body armor; Personal trauma patient and, 308 armor Angled contact wounds, 100 personal armor and, 68 Angle of yaw plate, BABT and, 86 bullet and, 96 stab, 82 tissue density and, 97 textile, 74 Animal studies, blast injury and, 52 bullet energy and, 74 Ankle brachial indices (ABIs), GSWs Armor systems and, 480 manufacturers of, 86 Antacids, spinal cord injury and, 352 projectile defeat and, 74 Anterior sternocleidomastoid (SCM), Arm, upper, injuries of, 373–374 232 Arterial incision blood flow, ballistic injury and, 381 children and, 404 emboli, 254 esophageal injury and, 233, 234 injury, 383 neck injury and, 226, 227 operative management of, 384–390 tracheolaryngeal wounds and, 235 spasm, child v. adult with, 413 630 Index

Arterial bleeding, children and, head humanity and, 131–132 trauma in, 399, 402 intensive care role in, 596–605 Arterial lines, 187–188 management training for, 486– Arteriography, vascular injury and, 383 510 Aspartate aminotransferase (AST), 55 MRI and, 466 Assault rifle round, 39, 40 public health and, armed violence AST. See Aspartate aminotransferase results and, 124–127 ATLS. See Advanced Trauma Life wound markers and, 466 Support Ballistic injury Atypical entrance wounds, 98, 107–109. arterial system and, 381 See also Entrance wounds austere environments and, 585– Auditory system 591 blast and, 53 bleeding and, preoperative control blast injury and, 53–54 of, 384 Austere conditions cervical collars and, 153–155 ABC and, 592 children and, 397–398 amputation and, 583 epidemiology of, 397–398 ballistic injury and, 585–591 prehospital care in, 398–399 bottled mineral water and, 580 resuscitation in, 398–399 emergency care and, 586 external fixation and, 372–373 hemorrhagic shock and, 581 hand and, 374–375 patient self management and, 590 imaging tools for, 481 surgeon in, 580–583 imaging triage for, 465–481 transfer and, 593 Johannesburg General Hospital Automatic weapon, 36, 37 Approach and, 499 Autonomic dysreflexia, spinal cord lessons learned in, Africa and, injury and, 353 592–593 AVPU Score, 144 limbs and, radiographs and, 377– Axillary artery injury, surgery for, 378 390–391 long-term consequences of, 573 military environment of, surgical B procedures and, 178 BABT. See Behind armor blunt trauma organic psychiatric problems and, Baer Hugger, hypovolemic shock and, 602 186 PHIs and, 343 Ballistic pregnancy and, 418–423 protection assessment and management coverage of, 69–70 during, 419 mechanics of, 68–69 related web site addresses for, threats and testing of, 71 508–509 textiles, 74 retained fragments and, 378 trauma, 122–124 Sarajevo siege and, 569–575 ATLS and, 490 specific organ injury and, 308–320 burn injury in, 424–443 spinal cord injury and, 348 children and, 396–414 surgical boundaries and, 308 epidemiological background of, survivors of, psychology of, 602 396–397 through-and through injury and, crime scene and, 145–146 622 CT imaging and, 466 treatment overview for, 360 Index 631

Ballistics, 94 Blast wave. See Dynamic overpressure PHI and, 326 Bleeding. See also Hemorrhage Ballistic trauma training liver injury and, 316 management of, surgeon competence preoperative control of, 383–384 in, 500 thoracic great vessel injuries and, 255 Balloon tamponade, vertebral artery vertebral artery and, 232–233 and, 232 Blood Barotrauma, 458 bank, DC-Ground Zero and, 188 Basic Life Support first aid, burn injury Lebanese civil war and, 588 and, 429 samples, analysis and, 113 BASICS website, prehospital stomach injury and, 310 environment and, 139 transfusions, NGOs field hospital Battlefield and, 549 explosive force and, introduction of, Blood-brain barrier, pulmonary 45–46 contusions and, 187 killing and, 600 Blood pressure, abdominal GSWs and, Lines of Care in, 535–536 300 Victims of War and, 589–590 Blood urea nitrogen (BUN), CS and, Battlefield Advanced Trauma Life 174 Support (BATLS), 150, 490, Blunt injury, 611–626 491 misdiagnosis and, 613 Behind armor blunt trauma (BABT), penetrating trauma v., 612 49, 84–87 prehospital care in, 611 Below-knee amputations, 554 prehospital information and, 612 Benzylpenicillin, burn injury and, 442 tertiary survey and, 452 Bicortical pin placement, external Body armor. See Combat body armor fixation and, 372–373 Bomblet, fragmentation injury and, 56, Bile duct injury, 317 57, 58 Biliary injuries, extrahepatic, 317 Bombs, 45 Bladder, 287, 288, 289 Bone(s). See also Fractures; Injuries; abdominal GSWs and, 320 Trauma NGO environment and, 559 exit wounds and, 106 penetrating injuries to fractures, KE and, 96 associated injuries and, 290 grafting, 374 classification of, 290 wound excision and, 172 clinical diagnosis of, 289 Bony injury imaging of, 290 First Line of Care and, 535 laboratory diagnosis of, 290 limb injury with, 365 management of, 291 Bore number, 36 outcome and complications of, 291 Bottled mineral water, austere Bladder injury scale, 334 environments and, 580 Bladder organ injury scoring system. Bouncing Betty. See Bounding mines See AAST Bladder organ Bounding mines (bouncing betty), 60 injury scoring system Bowel injury, NGOs field hospital and, Blast injury, 95 549 animal studies and, 52 Brachial artery, vascular injury and, 390 auditory system and, 53–54 Brain-injury. See also Head-injury solid organ injury with, 55 trauma and, 161 Blast lung, burn injury and, 427 Brazil, gun-related deaths and, 11 632 Index

Breathing airway and, 155–157 burns and, 431 assessment of, 439 chest injury and, 157 clingfilm and, 429 neck and, 214 cutaneous Breath sounds, ICU and, 446 epidermal burns and, 427 Britain, firearms in, death rates from, %TBSAB and, 427 9–10 definitive care transfer for, 436 British anti-Lewisite (BAL), Lewisite EBWs and, 49 toxicity and, 443 epidemiology of, 424–425 Bronchoscopy escharotomies and, 439 tracheobronchial injuries and, first aid for, 429 258–259 full thickness, 435, 436 VAP and, 458 infection in, 441–442 Bullet(s). See also Ammunition; inhalation injury in, 426, 438 Explosives; Hollow point rifle airway burn and, 426 bullets; Rifle(s); Shotguns lung injury and, 426 AK-47 rifle, 42 systemic toxicity and, 427 angle of yaw and, 96 initial medical care in, 430 assault rifle, 39, 40 managing, 428–429 atypical entrance wounds and, 107 mass casualty scenarios and, 443 BABT and, 85 monitoring, 435 ballistic protection, 71 NGO environment and, 561, 563 deformation of, 97 partial thickness, 428 drag force and, 97 deep dermal, 428 effects of, 40–41 full thickness, 428 energy, armors and, 74 superficial dermal, 428 forensics and, 94 pathophysiology of, 425 full metal jacket, 40 personal armor and, 67 gunshot evidence and, 115 principle of definitive care in, 437 handgun round, 40 referral criteria for, 436 high-energy, BABT and, 84 SIRS and, 441 jacketed hollow point, 40 special, 442–443 KE and, 40–41, 96 systemic injury in, 426 knife protection v., test standards for, thermal, 442 81 transfer preparation in, 436–437 M-6A1 rifle, 43 vesicant, 442 M-16, 85 wound and, 435–436 mechanism of injury with, 42–44 wound healing in, 441 pistol v. rifle, 39 Burn management rubber, 40 burn size and, 432 soft point, 40 inhalation injury and, 432 trajectory, aerodigestive injury and, Burn shock, 434 216 Burr hole, penetrating head injury and, Bullet wounds 560–561 abdominal GSWs and, 301 characteristics of, 43 C BUN. See Blood urea nitrogen CAB. See Catastrophic hemorrhage, Burn(s), 424–443. See also Airway; airway, and breathing Escharotomy Calf, fasciotomy of, 176–177 Index 633

Capsular laceration, pancreas injury intraventricular, 335 and, 313 IV, ICU and, 447 Carbines, history of, 32, 35, 36 spinal cord injury and, 353 Carbon monoxide, burn injury and, 427 CBA. See Combat body armor Carboxyhemoglobin levels, burns and, CBC. See Complete blood count 432 CBD. See Common bile duct Cardiac CCA. See Common carotid arteries bleeding, 253 CDC. See Centers for Disease Control injury, 252–254 Centers for Disease Control (CDC), ischemia, 165 gun-related deaths and, 9 monitoring, ICU and, 450 Central America, gun-related deaths tamponade, 252 and, 10–11 clinical manifestations of, Central lung injury. See Injuries 244–245 Central nervous system (CNS), blast thoracic wounds and, 244–245 injury and, 55 Cardiopulmonary bypass, 253 Central spinal fluid (CSF) fistula, 342 Cardiopulmonary resuscitation (CPR), PHIs and, 343 bullet wound and, 623 Central venous pressure (CVP), Cardiovascular system, pregnancy and, anesthesia and, 164 419 Cephalosporin, burn injury and, 442 Care Under Fire, non-permissive Ceramic plate. See Rigid ceramic environment and, 137 plate Carotid artery Cerebral angiogram, carotid artery injuries injuries and, 229 repair of, 230–232 Cerebral edema, children and, 400 trauma management and, 228–233 Cerebral perfusion pressure (CPP), neurologic examination and, 214–215 PHI and, 337 operative anatomy of, 211 Cerebral spinal fluid (CSF), PHI and, shunts, 389 341 injuries and, 230 Cervical collars vascular injury and, 391–392 ballistic injury and, 153–155 Cartridge, 31, 36 ICU and, 446 cases, gunshot evidence and, 115 Cervical spine Cartridge-discharge residue (CDR), immobilization, penetrating neck 94 injury and, 215–216 Case study, DGE and, 606–607 non-permissive environment and, Casualty 142 armor removal and, 87–88 penetrating trauma and, 143 fault-line wars and, 542 Cervical stab injury, children and, 402 gun-related deaths and, 11–14 Cervical vascular organ injury scale, transfer, NGO field hospital and, 324 563–564 Cesarean section triage and, 532 ballistic injury and, 422 Casualty Reduction Analysis model, post-mortem, 422 armor and, 72 CFD. See Color flow Doppler Catastrophic hemorrhage, airway, and CG. See Computer-generated training breathing (CAB), 142 environment Catheters. See also Fogarty catheters; Chain of Care Foley catheter evacuation and, 144–145 634 Index

Chain of Care (cont.) Chip fracture, 365 hospital and, 145 Chloramphenicol transfer and, 145 head trauma and, 561 Chain of custody, gunshot and, 116 NGOs field hospital and, 548, 549 Chemical warfare agents, burns and, Choking, 36 442 Cholecystojejunostomy, bile duct injury Chest drainage and, 317 chest tube insertion and, 249 Cholesteatoma, blast injury and, 53 children and, 404 Circulation, 149 sizes by age for, 405 anesthesia and, 165–166 Chest injury burns and, 431 AP radiograph and, 472 injured patient and, 157–160 chest retractors and, 617, 618 Civilian injury chest tube and, 614 military injury v., 359–360 thoracotomy and, 251–252 PHI and, 343 Chest retractors, chest injury and, 617, weapon use and, framework 618 application for, 127–128 Chest tube Civilian medical practice, missiles lateral chest injury and, 614, 616 emboli and, 254 thoracic wounds and, 248–249 Clam shell incision, children and, 408 Chest wall injury scale, 325 Class characteristics, 115 Children. See also Ballistic injury, Clingfilm, 435 children burn injury and, 429 abdominal injury in, 409–410 Closed-cell polymeric foam, 77 ballistic trauma in, 396–414 Close-range wounds, 101, 272 burn injury and, 426 Clothing handling chest drain in, 404 gunshot evidence and, 114 insertion technique for, 404 intermediate range wounds and, clam shell incision and, 408 104 definitive thoracotomy and, 408 Clotting cascade, 187 DPL and, 409 CNS. See Central nervous system firearms damage and, 8–9 Coagulopathy head injury in, 399–402 abdomen and, 617, 619, 620 median sternotomy and, 422 austere environments and, 581 methylprednisolone and, 403 ICU and, 454 midline incision in, 411 trauma patient and, 187–188 neck incisions in, 403–404 Code of Conduct, 20 neck injury in, 402–404 Collar incision, tracheolaryngeal penetrating injury, weapons and wounds and, 235 patterns of, 397–398 Colloid resuscitation, ICU and, 449 peripheral vascular injury in, 411 Colon prehospital care with, 399–402 injury resuscitation with, 399–402 abdominal GSWs and, 319 resuscitative thoracotomy and, 408 NGO environment and, 559, 560 RT and, 406–407 penetrating renal injuries and, spinal cord injury and, 403 282–283 thoracic injury in, 404 repair, penetrating abdominal thoracoscopy in, 406 wounds and, 573, 574 X-ray and, 404–406 Colon injury scale, 331 Index 635

Color flow Doppler (CFD), neck injury penetrating renal injuries and, 274, and, 221 283 Columbia, gun-related deaths and, 11 PHIs and, 326, 333, 334, 335, 336, 344 Combat pregnant abdomen and, 421 genital injuries and, 291–293 spinal cord injury and, 350 killing and, 601 tertiary survey and, 199–200 Combat body armor (CBA), 69. See thoracic wounds and, 248 also Helmets, ballistic; Knife transcervical GSWs and, 217, 218 protection; Protective armor transmediastinal injuries and, bullet perforation and, 88 472–475 deformation of, 86 Computed tomography angiography Kevlar, 85 (CTA), neck injury and, law-enforcement agencies and, 220–221 BABT and, 86 Computer-generated (CG) training lightweight flexible, police and, 86 environment, 498 medical issues with, casualty Conoid fracture, bullet and, 76 numbers and, 83–84 Constriction, 36 police and, 79, 80 Contact wounds, 107 police v. military, 79, 80, 81 entrance wounds and, 98–101 removal of, 87–88 Contamination torso and, 81–83 DC 1 and, 193–194 toxicities and, 59 trauma laparotomy and, 306 UK’s, 79 war surgery and, 558 Combat Casualty Evacuation Care, 137 war wounds and, 60, 168 permissive environment, 138 Continuous Positive Airway Pressures Combat helmets. See Helmets, (CPAP), 53 ballistic Continuous veno-venous hemodialysis Comminuted fracture, 365 (CVVH), ICU and, 461 Common bile duct (CBD), duodenum Contrast enhanced CT scan, ballistic injury and, 311 abdominal trauma and, Common carotid arteries (CCA), 210 477–480 Compartment syndrome, 175–177 Contrast esophagography, esophageal wound surgery and, 551 perforation and, 474 Complete blood count (CBC), PHIs Copper sulfate, burns and, 442 and, 332 CPAP. See Continuous Positive Airway Complex fracture, Sarafix and, 573 Pressures Compressive stress wave, 51 CPP. See Cerebral perfusion pressure Computed tomography (CT) CPR. See Cardiopulmonary abdominal GSWs and, 302, 476 resuscitation ballistic trauma and, 465, 466 Craniocerebral injuries. See Cushing chest, entrance wound and, 474 and Matson’s classification of children and, 406 craniocerebral injuries head trauma in, 400, 402 Craniotomies, Lebanese civil war and, diaphragm injuries and, 480 587 GSW on, 332, 471 Cricothyroidotomy, airway and, 156 ICU and, 447 Crime scene, 145–146 intestinal injury and, 55 Critical Incident Stress Debriefing, lateral chest injury and, 616 604 neck injury and, 209, 468–471 Cruciform entrance wound, 99 636 Index

Crush syndrome (CS), 175–176 Damage control (DC) III laboratory findings in, 175 abdominal closure and, 202–203 Crystalloid penicillin, 433, 434 definitive reconstruction, 201–204 NGOs field hospital and, 549 delayed fascial closure and, 203–204 CSF. See Cerebral spinal fluid Damage control (DC) pathway, CS. See Crush syndrome triggers used for, 185 CTA. See Computed tomography Damage control (DC) surgery, 180–208 angiography history of, 181–184 CT. See Computed tomography (CT) pathophysiology for, 184–185 Cushing and Matson’s classification of patient selection for, key factors for, craniocerebral injuries, 328 184 Cutting diathermy, burns and, 440 three phase approach to, 182, 183 CVP. See Central venous pressure DC. See Damage control CVVH. See Continuous veno-venous Deadly triad, reversing, 453 hemodialysis Death, soldiers experience of, 599–601 Cyanides, burn injury and, 427 Debridement. See Surgical Cystogram, bladder, 292 debridement Cystography, bladder injury and, 290 Deep neck space, operative anatomy of, 212 D Deep vein thrombosis (DVT) Dacron patch, carotid artery injuries ICU and, 450 and, 230 spinal cord injury and, 353 DALYs. See Disability-adjusted life Default transport, 145 years Definitive burn care, 451. See also Damage control (DC), 624 Burn(s) abdomen and, 617, 620 Definitive care, trauma practitioner abdominal closure and, 194, 195 and, 495 abdominal GSWs and, 307 Definitive reconstruction, DC III and, acidosis and, 186–187 201–204 coagulopathy and, 187–188 Definitive Surgical Trauma Care ECG and, 189 (DSTC) course, 495–496, 500, essential equipment for, 189 624 hemorrhage and, 190–193 core curriculum for, 504–508 hypothermia and, 185–186 principles for, 614 ICU and, 447 Definitive thoracotomy, children and, incisions, 190 408 initial laparotomy and, 189–197 Delayed primary closure, wound NGOs field hospital and, 548 surgery and, 551 orthopaedics, 204 Desmopressin, ICU and, 454 surgical bleeding and, 197 Detonator, 46 trauma, system applications and, 205 Diagnosis, delayed, 624 trauma and, 160 Diagnostic equipment Damage control (DC)-Ground Zero, hospital and, 520–521 prehospital setting and, 188 NGOs field hospital and, 548 Damage control (DC) II thoracic wounds and, 247–248 Factor VII and, 198–199 Diagnostic laryngoscopy (DL), ICU resuscitation and, 197–198 tracheobronchoscopy and, 225 tertiary survey and, 199–200 Diagnostic peritoneal lavage (DPL) unplanned reoperation and, 200–201 abdominal GSWs and, 302 Index 637

blast injury and, 55 DRE. See Digital rectal examination children and, 409 Dressings, burns and, 442, 561 Diaphragm injury, 262–263 Drill-hole fracture, 365, 367 CT and, 480 Drugs. See also Specific drugs i.e. incidence of, 309 Penicillin management of, 310 prehospital care and, 149 NGO environment and, 559 DSTC. See Definitive Surgical Trauma Diaphragm injury scale, 327 Care course Diazepam, Lebanese civil war and, 586 Duodenum injury, 311 DIC. See Disseminated intravascular NGO environment and, 559 coagulation Duodenum injury scale, 330 Digital probing, lateral chest injury Dural sinus, PHIs and, 338 and, 616 DVT. See Deep vein thrombosis Digital rectal examination (DRE) Dynamic overpressure, 46 colon injury and, 319 EBW mechanism and, 49 lesson learned from, 606–607 enhanced, 49 Directional fragmentation mines, 61 Disability E burns and, 431 EBWs. See Enhanced-blast weapons trauma and, 160–161 ECA. See External carotid artery Disability-adjusted life years (DALYs), ECG. See Electrocardiograph deaths and, 6 Echelons of care. See Lines of Care Disappearances, reporting framework Echocardiography, children and, 406 for, 128–131 Economic Community of West-African Disseminated intravascular coagulation States (ECOWAS), 20 (DIC), 165, 188, 342 ECOWAS. See Economic Community Distal duodenal mobilization, small of West-African States bowel injury and, 318 Elbow joint, fractures of, 373 Distance-range wounds, 104–105 Electrocardiograph (ECG) shotgun entrance, satellite pellet anesthesia and, 163 wounds and, 111 DC and, 189 Divot fracture, 365, 367 Elemental analysis, GSWs and, 104 DL. See Diagnostic laryngoscopy Elevated lactate dehydrogenase Documentation (LDH), 55 forensic evaluation and, 92, 93 Eley cartridge, 38 GSWs and, 93 Emboli, limb injury and, 624, 625 intermediate range wounds and, Embolization, liver injury and, 316 103 Emergency care, austere environments Doppler and, 586 fetoscopy, 421 Emergency medical service (EMS) hand-held, GSWs and, 480 DC-Ground Zero and, 188 studies, vascular injury and, 383 PHIs and, 330 Doppler Artery Pressure Index (API), trauma resuscitation and, 492, 493 vascular injury and, 411 Emergency room (ER) DPL. See Diagnostic peritoneal lavage clothing and, gunshot wound and, Drag force, bullet and, 97 114 Drain removal, chest tube insertion firearms morbidity and, 6 and, 249 forensic medicine and, 91 Draping, GSWs and, 304 imaging and, 467 638 Index

Emergency room thoracotomy (ERT), injury, 260–262 249–251 management of, 233–234 chest injury and, 616 perforation, contrast OR thoracotomy v., 614 esophagography and, 474 Endemic diseases, NGOs field hospital wounds, pharyngeal wounds v., 234 and, 544 Esophagus injury scale, 330 Endotracheal tube Europe, firearms in, death rates from, airway and, 154 9–10 ICU and, 446 Evacuation ventilation and, 165 Chain of Care and, 144–145 Endovascular stents, neck trauma and, front line and, surgery near, 588 233 hospital, Iraq conflict and, 597 Energy. See also Kinetic energy spinal cord injury and, 354 explosions and, 46 Evaluation, injury-prevention model missiles and, 69 and, 21–23 personal armor and, 67 Evidence, 112 Enhanced-blast weapons (EBWs), chain of custody and, 116 47–51 explosives and, 116 combined injury and, 64–65 informational, 112 currently used, 48 physical, 112–113 thermal blasts and, 56 Excretory urogram, penetrating renal Enterotomies, small bowel injury and, injuries and, 274 318 Expert witness, GSWs and, 93 Entrance wounds, contact wounds and, Explosions, 46–47 98–101 Explosive force, 31 Environment battlefield and, introduction of, 45–46 ballistic casualties and, 161 Explosive ordinance disposal (EOD) ballistic missile injuries and, 569, 570 equipment, 65 explosives in, burns and, 431 bomb disposal suits and, 80–81 killing and, 600 personal armor and, 68 Environmental debris, fragment removal of, 87 wounding and, 59 Explosives EOD equipment. See Explosive evidence and, 116 ordinance disposal equipment small arms and, 4 ER. See Emergency Room Exposure/Environment, burns and, ERT. See Emergency room 431 thoracotomy Extension of task, 148 Escharotomy External carotid artery (ECA), 210 burn injury and, 435, 437 External fixation lines of election for, 440 ballistic injury and, 378 Esophagography fractures and, 372, 379 esophagoscopy v., 223–224 technique of, 372–373 neck injury and, 223–224 External splints, fractures and, 369 Esophagoscopy Extrahepatic bile ducts, NGO esophageal injuries and, 261 environment and, 558 esophagography v., 223–224 Extrahepatic biliary tree injury scale, neck injury and, 223–224 329 Esophagus, 308–309 Extraliminal balloon tamponade, evaluation, neck injury and, 222–224 bleeding and, 384 Index 639

Extremity gunshot wounds (GSWs), Fibrin glue, liver injury and, 316 ABIs and, 480 Field intensive care facilities Eyes. See also Ocular injury DRE and, 606 blast injury and, 54 Iraq conflict and, 596 Field surgical teams (FSTs), war F surgery and, 537 Face Finger fracture, liver injury and, 316 GSW to, surgical challenges of, 621 Firearm-discharge residue (FDR), 94 injury Firearms, 31. See also Rifle(s); Shotguns mine blast and, 562 Canada exports and, 15 NGO environment and, 561 civilian, 5 Facial compartments civilian possession of, 19 compartment syndrome and, 175 death rate, Canada v. US in, 24 wound surgery and, 551 economic impacts of, 7–8 Fact-based interventions, injury- forensic aspects of, 94–95 prevention model and, 3–4 health and, 7 FAE. See Fuel-air explosive bombs history of, 31 Fallopian tube injury scale, 335 injury, forensic evaluation with, 92 Fascial closure mechanism of injury with, 41–44 definitive reconstruction and, bullet effects in, 42–44 201–204 resources on, 23–24 delayed, 203–204 rights arguments and, 16–17 Fasciotomy social and environmental costs of, 7 calf, 176–177 working mechanics of, 31–40 compartment syndrome and, 176 Fireball (flash) foot, 177 EBW mechanism and, 48 forearm and, 374 injury with, 56 Sarajevo siege and, 572 Fistulas thigh, 176 abdominal GSWs and, 321 vascular injury and, 388, 389 colon injury and, 319 wound management, 177 Flaccid paralysis, spinal shock and, 350 FAST. See Focused abdominal Flash. See Fireball sonogram for trauma Flechets, 58 Fault-line wars, casualty figures from, Flexion deformities, Sarajevo siege 542 and, 573 Fecal Occult Blood Test, pelvic injury Flucloxacillin, burn injury and, 442 and, 606 Fluid replacement therapy, burn injury Femoral artery and, 561 graft repair of, 385 Fluids vascular injury and, 390–391 burn injury and, 438 Femoral fractures, 356, 357, 358, 369, burns and, 434–435, 442 371 hypotensive resuscitation and, 159 Femoral vessels Fluothane, Lebanese civil war and, groin and, 577 586 injury, 576–577 Focused abdominal sonogram for Fetal injury, penetrating maternal trauma (FAST), 64 trauma and, 414–415 abdominal GSWs and, 302, 476 Fetus, ballistic injury and, 420 Fogarty catheters, arterial injury and, FFPs. See Fresh frozen platelets 384 640 Index

Foley catheter, 384–385 simple, 366 penile injuries and, 292 stabilization of, 368 Foot external splints and, 369 fasciotomy of, 177 internal fixation and, 370 fractures and, 376–377 intramedullary fixation and, 370 GSW and, 377 plaster and, 369 Forearm, surgical debridement and, 374 traction and, 369–370 Foreign materials, wound surgery and, upper limb injury and, 374 551 Fragmentation injury, 56–60 Forensic military v. civilian, 95 ballistic laboratories, test firing and, Fragmentation weapons, 50, 56–60 103 Fragments evaluation personal armor and, 68 firearm injury and, 92 retained, ballistic injury and, 378 gunshot victim and, 118 Fragment wounding evidence, gunshot and, 112 bacterial contamination and, 60 medicine, 91 environmental debris and, 59 evaluation in, 92 Fresh frozen platelets (FFPs), ICU terminology, 94 and, 454 Formal bypass graft, carotid artery Friedlander Relationship, blast wave injuries and, 230, 231 and, 46–47 Forward surgical teams (FSTs), 497, Front line, surgery near, 588 537 FSTs. See Forward surgical teams or structure of, personnel, 537 Field surgical teams war surgery and, 537, 538 Fuel-air explosive (FAE) bombs, 47, Fractures 56 ballistic, nonoperative management EBW mechanism and, 48 of, 378 Full metal jacket, 39 bony injury with, 365, 366, 367–373 Fulminate of Mercury, potassium complete v. incomplete, 365 chlorate and, 46 drill-hole, 367 elbow joint, 373 G external fixation and, 372 Gallbladder injury, 317 forearm injury and, 374 Gastrogaffin, 474 hand injury and, 374 Gastrointestinal (GI) tract, blast injury IM fixation and, 370 and, 54 incomplete divit, 368 GCS score. See Glasgow Coma Scale limb injuries and, 356, 357, 358 score lower limb injury and, 375 Gelfoam, DC and, 193 foot and, 376–377 Gelignite, 46 lower leg, 375–376 General Medical Council (GMC), UK, thigh and, 375–376 ballistic injury and, 91 multifragmentary, 367 Geneva Convention, weapons and, 17 NGOs field hospital and, 554–555 Genital injury, 291–293 Sarajevo siege and, 572 clinical findings of, 292 secondary management of, 378–379 management of, 292–293 external fixation and, 379 mines and, 272–273 joint involvement and, 379 outcome and complications of, 293 plaster and, 378 radiological findings of, 292 Index 641

Genitourinary system Specific type i.e. Abdominal SGW and, 270 gunshot wounds stab wounds and, 270 abdominal, 300, 475 Gentamicin, burn injury and, 442 Africa case study and, 595 GI tract. See Gastrointestinal tract appearances of Glasgow Coma Scale (GCS) score, entrance wounds and, 98–104 335 exit wounds and, 105–106 PHIs and, 333, 343, 344 forensic terminology and, 98–112 trauma and, 144 characteristics of, 110 Glutamine, trauma patients and, 461 children and Glycemic control, ICU and, 457 head trauma in, 399, 402 Grenade launchers, fragmentation peripheral vascular injury in, 411 injury and, 56 classification of, 110 Grief, 604 cranial, prognostic outcome in, 402 Groin, vascular injuries in, 576–578 CT after, 471 Ground brief, 147 CT of, 339 GSR testing, 113 documentation and, 93 GSWs. See Gunshot wounds DRE and, 606 Guidelines of Penetrating Head Injury, face and, 154 PHI and, 341 femur and, 375 Guidelines to Penetrating Brain foot and, 377 Injuries, 343 forensic concepts and, 94 Guillotine amputation, wound surgery forensic evaluation and, 92 and, 552 humerus and, 358 Gulf War kinetic energy transfer, 95 abdominal wounds and, 299 pediatric, 411 hemorrhage and, 158 penetrating, 98 training exercises and, 152 penetrating renal injuries and, 282 wounds in, 360 perforating, 98 Gum-elastic bougie, 154 rectum and, failure to evaluate, Gun control legislation, 22 620 Gun-free zones, 21 thoracic great vessel injuries and, Gun-owner registration, 23 255–257 Gunpowder, 31 tracheolaryngeal wounds and, Gun-related deaths, causal factors of, 234–235 11–14 undiagnosed, 623 Gunshot ureter repair, 287 injury, challenges of, 614 Gun violence, civilian, 299 pellets, 110 victims H deceased, 115–116 Haemophilus influenza, VAP and, evidence and, 112–113 458 wound descriptions and, 117 Haifa hospital, war surgery and, 589, Gunshot residue (GSR), 94 590 Gunshot wounds (GSWs). See also Handgun Epidemic Lowering Plan Extremity gunshot wounds; (HELP), 23 Hepatic gunshot wounds; Handgun round, 39 Injuries; Transmediastinal Handguns, murders with, 22 gunshot wounds; Wound(s); Hard-contact wounds, 96, 99 642 Index

Head Hemodynamic status, penetrating renal surgeon challenges and, 621–623 injuries and, 273 wounding missiles and, 70 Hemorrhage. See also Massive Head-injury. See also Vietnam Head hemorrhage; Subarachnoid Injury Study hemorrhage children and, 399–402 abdominal GSWs and, 321 NGO environment and, 560 compressible, 158 trauma and, 160 DC and, 190–193, 204–205 Health-care system DC surgery and, 181 organizations, firearms and, 23 First Line of care and, 535 personnel, pre-deployment and, 579 injured patient and, 157–160 system assessment neck and, 214 epidemiology and, 515 noncompressible, 158 funding, 515 non-permissive environment and, healthcare access and, 515 142 human resources and, 515 pericardium and, 252 logistics and, 515 PHIs and, 338 prehospital care and, 514 preoperative control of, 384 security and, 515 trauma laparotomy and, 305 surgery in, structure location for, Hemorrhagic shock, austere 515 environments and, 581 system structure and, 514 Hemostatic agents, topical, liver injury weapon wounded and, 513–516 and, 316 Hearing loss, blast injury and, 53–54 Hemothorax, VATS and, 252 Heart, pledgets suturing and, 594 Heparin, 400. See also Intermittent Heart injury scale, 325–326 subcutaneous (SQ) heparin Heart murmur, cardiac injury and, 253 arterial injury and, 384 Heat lamps, hypovolemic shock and, Hepatic artery ligation, liver injury 186 and, 316 Helical CT scans, 261 Hepatic gunshot wounds (GSWs), Helicopter landing site (HLS), Chain contrast enhanced CT scan, of Care and, 145 477–480 Helmets, ballistic, 77, 78–79 Hepatic tractotomy, liver injury and, bullets and, 68 316 patterns of, 77 HE. See High explosives penetrating missiles and, 69 H/H. See Hematocrit/hemoglobin personal armor and, 76 High energy transfer gunshot wounds removal of, trauma and, 88 (GSWs) HELP. See Handgun Epidemic children and, abdominal injury in, Lowering Plan 409–410 Hematocrit/hemoglobin (H/H), vascular injury and, 381 CS and, 174 wound excision for, 553 Hematuria High explosives (HE), 46 pediatric abdominal injury and, 410 blast injury and, 46, 48 penetrating renal injuries and, 273 High velocity missiles, wounds and, 60 penetrating ureteral injuries and, 284 High velocity projectiles, 270 Hemi-amputation, pediatrics and, 583 misconceptions about, 95 Hemodynamic stability, DC surgery HIV. See Human immunodeficiency and, 181 virus Index 643

HLS. See Helicopter landing site Hydrocephalus, postsurgical Hollow point rifle bullets, 97 complications and, 342 Homicide, 6 Hyperbaric oxygen, inhalation injury Horizontal spray mines, 61 and, 439 Hospital. See also Nongovernmental Hyperchloremic acidosis, 434–435 organizations; Postoperative Hyperglycemia, acute renal failure and, care; Prehospital care; 461–462 Prehospital environment Hyperkalemia, cardiac arrhythmia and, care, CS and, 175 174 Chain of Care and, 145 Hypertension, penetrating renal clinical services in, 524 injuries and, 283 consumable supplies in, 521–522 Hypertonic saline dextran (HSD), 159 equipment in, 520–521 Hyperventilation, ICP and, 337 medical, 520–521 Hypotension non-medical, 521 abdominal GSWs and, 300 expertise in, 522 differential diagnosis of, 165–166 finance and funding for, 524–252 maternal, 420 front line and, 588 Hypotensive resuscitation, 159–160 infrastructure of, 519 anesthesia and, 163 buildings around, 519–520 fluids and, 159 electricity and, 520 transfusion protocols and, 160 maintenance in, 520 Hypothermia medical, 519 abdomen and, 617 sewage and sanitation in, 520 ballistic casualties and, 161 waste disposal in, 520 DC and, 185–186 water and, 520 ICU and, 455 medical staff in, 523–524 Iraq conflict and, 596 NGO and, 543–545 Hypovolemia nursing staff in, 523–524 burn injury and, 561 protection of, 517–519 ICU and, 449 resource-limited situations in, Hypovolemic shock, 186 525–526 security of, 517–519 I system assessment and, 513–526 IAP. See Intra-abdominal pressure Hospital assessment, individual, IATSIC. See International Association 516–525. See also Health-care for Trauma and Surgical system Intensive Care Hospital supplies. See Supplies, ICP. See Increased cranial pressure hospital ICRC. See International Committee of HSD. See Hypertonic saline dextran Red Cross Human immunodeficiency virus (HIV), ICU. See Intensive care unit firearms damage and, 8 Imaging. See also Computed Humanitarian law, 122–124 tomography; Magnetic Humanity, ballistic trauma and, resonance imaging; 131–132 Neuroimaging; Radiographs Human rights abusers, 19 abdominal injury and, 475 Humerus, fractures and, 371 battlefield conditions and, 481 Hydralazine, spinal cord injury and, craniofacial injuries and, 467–468 353 neck injury and, 468–471 644 Index

Imaging. (cont.) Injuries. See also Abdominal injury; prehospital, 481 Blast injury; Blunt injury; transmediastinal injuries and, Burn(s); Civilian injury; 472–475 Genital injury; Limb injury; IM fixation. See Intramedullary fixation Liver injury; Overpressure; Impalement injury, 260 Primary blast injury; Soft Inceptor Body Armor, 49 tissue injury; Spinal cord Incision(s) injury; Spleen injury; chest injury and, 617, 618 Stomach injury; Thoracic; DC and, 190 Thoracoabdominal injuries; longitudinal, extremity wounds and, Ureteral injury; Vascular 550 injury; Specific organ injury oblique iliac fossa, inguinal ligament i.e. Ocular injury and, 576, 578 ballistic RT and, 406–407 clinician role in, 91–92 thoracic access and, children and, forensic aspects of, 91–118 407–408 central lung, hilum clamping and, 250 transverse, neck injury and, 227 classification of, by mechanism, 50 vertical, groin and, 577 combined, 64–65 Incomplete contact wounds, 101 fetal, penetrating maternal trauma Increased cranial pressure (ICP) and, 414–415 intraventricular catheters and, 335 impalement, 260 PHI and, 335 land mines and, patterns of, 62 Infants, post-mortem cesarean section lower limb, 64, 623 and, 422 ocular, mines and, 62 Infection(s). See also Contamination; scrotal, 292 Sepsis; Septic shock shotgun, 177–178 1st Line of Care and, 536 small bowel, abdominal GSWs and, austere conditions and, 590 318 blood stream, ICU and, 459 solid organ, blast injury with, 55 ICU and, 457 spine, tertiary survey and, 452 PHIs and, 340, 341 subclavian vascular, 256 pin tract, 571, 572 thoracic duct, 263 presurgical care and, 168 thoracoabdominal, 262–263 Sarajevo siege and, 571 Injury classification, PHI and, 327 spinal cord injury and, 353 Injury-prevention model Inferior mesenteric vessels, NGO EBW mechanism and, 48 environment and, 560 evaluation and, 21–23 Inferior vena cava (IVC) fact-based interventions and, 3 liver injury, 315–316 Instability, spinal cord injury and, 350 pregnancy and, 420 Intensive care Inguinal ligament, oblique iliac fossa Iraqi patients and, 597 incision and, 576, 578 role of, ballistic trauma and, 596–605 Inhalation injury, 432 trauma patient in, ballistic injuries airway edema and, 438–439 in, 445–463 burns and, 438, 442 Intensive care unit (ICU) Initial laparotomy acute renal failure in, 461–462 DC part 1 and, 189–197 arrival in, penetration injury and, preparation for, 189 445–447 Index 645

blood stream infections in, 459 International Committee of Red Cross coagulopathy and, 454 (ICRC) hospital, 545 contemporary issues for, 457 surgical procedures in, 547 daily maintenance in, 449–450 International Crime Victimization deadly triad and, 453 Survey, 5 DM in, 453 International Federation of Red Cross. ERT and, 251 See Red Cross esophageal injuries and, 617 International humanitarian law, hyperglycemia and, 461–462 hospital protection and, hypothermia, 455 517–518 missed injuries in, tertiary survey International law, rights arguments and, 451 and, 17 nutrition in, 460–461 International Red Cross Organization. open abdomen and, 455–456 See International Committee OR and, 456 of Red Cross resuscitation, DC II and, 197–198 International relief aid, firearms team, penetration injury and, 446 damage and, 8 travel from, 462 Interventional radiology (IR), neck Intermediate range wounds, powder injury and, 209 tattooing and, 102 Interventions, small arms trade and, Intermittent positive-pressure 18–21 ventilation (IPPV), anesthesia Intestinal system. See Gastrointestinal and, 164–165 tract Intermittent subcutaneous (SQ) Intra-abdominal abscess, 311 heparin, ICU and, 450 Intra-abdominal esophagus Internal carotid artery, vascular injury abdominal GSWs and, 308–309 and, 389 injury of Internal fixation incidence of, 308–309 fractures and, 370, 371 management of, 309 plates, 373 Intra-abdominal organ injuries, war Internal jugular vein (IJV), 210 surgery and, 557 NGO environment and, 561 Intra-abdominal pressure (IAP), SCM and, 227–228 monitoring of, 200–201 International Association for Trauma Intracerebral hematoma, 338 and Surgical Intensive Intracranial pressure, children and, 400 Care (IATSIC), 489, 495, Intramedullary (IM) fixation, fractures 496 and, 370, 371 International Committee of Red Cross Intramedullary (IM) nailing, 373 (ICRC), 498 fractures and, 370, 371 antipersonnel mines and, 46 Intraperitoneal colon, NGO firearms deaths and, 6 environment and, 559 framework questions and, 128 Intrathoracic injuries, war surgery and, hospital protection and, 518–519 557 Lebanese civil war and, 589 Intravascular shunts, DC and, 192 NGOs and, 543 Intravenous (IV) catheters, ICU and, Sarajevo siege and, 575 447 surgical courses with, Sarajevo siege Intravenous (IV) fluids and, 575 ICU and, 447 wound classification of, 379 prophylactic, burns and, 434–435 646 Index

Intravenous pyelogram (IVP), Kidney penetrating renal injuries and, abdominal GSWs and, 320 274 GSWs and, 270 Intraventricular catheters, ICP and, 335 NGO environment and, 559 Intraventricular hematoma, 338 rhinorrhaphy and, 279 Investigations, lateral chest injury and, SGW and, 270 614 Kidney injury scale, 333 Ioban, abdominal closure and, 194 Killed in Action (KIA), wound IPPV. See Intermittent positive- distribution of, 69, 70 pressure ventilation Killing, battlefield, 600 Iraq Kinetic energy (KE) conflict, field intensive care facilities bullets and, 40–41 and, 596 density, 76 patients, intensive care and, 597 PHI and, 326 transfer team repatriation in, 597 transfer IR. See Interventional radiology factors determining, 95–98 Ischemia gunshot wound and, 95 arterial blood flow and, 381–382 transfer variables, 98 hypovolemic shock and, 186 Knee joint, amputation and, 552 vascular injury and, 382 Knife protection (armors), 82, 83 Isotonic crystalloid, ICU and, 449 bullets v., test standards for, 81 Israeli-Lebanese conflict, PHI and, 326 Knives, 67 IVC injuries. See Juxtahepatic inferior torso armor and, 81–83 vena cava injuries Kocherization of duodenum, 311 IVC. See Inferior vena cava Korean War, PHI and, 326 IVP. See Intravenous pyelogram IV. See Intravenous L Laboratory J findings, CS and, 175 Jacketed hollow point, 39 samples, gunshot evidence and, 113 Japan, firearms in, 16 Lactated Ringer’s (LR) solution, ICU Johannesburg General Hospital and, 449 ballistic injury and, 499 Lactate levels, ICU and, 449 trauma unit in, African education in, Land mines, 60–64 594–595 Laparoscopy, abdominal GSWs and, Joints, fractures and, 379 302 Juxtahepatic inferior vena cava (IVC) Laparotomy, 524 injuries, 314 abdominal GSWs and, 301, 303, 475 austere environments and, 581, 582 K DM and, 620 KE. See Kinetic energy DRE and, 606 Ketamine NGO environment and, 560 anesthesia maintenance and, 163 postoperative management and, 320 Lebanese civil war and, 586 ureter and, 285 Kevlar soft-body armor. See also war surgery and, 557 Combat body armor Laparotomy packs, 307 BABT and, 85 spleen injury and, 317 vests and, 21 Laryngotracheal evaluation, neck KIA. See Killed in Action injury and, 224–225 Index 647

Laryngotracheal injury mobilization in, 315 endotracheal approach in, 225 perihepatic packing in, 315 physical examination in, 225 track tamponade and, 316 Lateral chest injury vena cava control in, 315–316 management of, 614 NGO environment and, 558 trauma surgeon and, 614 Liver injury scale, 328 Law-enforcement agencies, body armor Liver packing, 307 and, BABT and, 86 Liver tampon, DC and, 193 LDH. See Elevated lactate Liver trauma, aprotinin and, 166 dehydrogenase Loose-contact wounds, 100, 101 Lebanese civil war, war surgery during, Lower limb injury. See Injuries 585–591 Low-velocity handgun, thoracic injury Left visceral rotation, 279 and, 614 Lethal triad, 180 Low velocity projectiles, 272 Level One trauma center, 496 Lund and Browder chart, %TBSAB urban, 497 and, 434 Light weapons, 4 Lung injury scale, 326 Limb injury Lungs amputation and, 362–363 airway burn and, 426 bony injury with, 365, 366, 367–373 blast injury to, 51, 53 challenges in, 623–639 DC and, 204–205 lower, 623 injuries of, hilum clamping and, previous wars and, 571 250 resuscitation for, 360–361 surgery for, 361 M technique in, 361–362 M-6A1 rifle, 43 tourniquets and, 364 M18A1 Claymore AP munition mine, treatment overview for, 360 61 upper, 373–375 M79 grenade launcher, retained wound closure and, 364 ordinance and, 65 wound surgery on, 550 Machine guns, 36, 37 Limb wounds, 356 Magazine, shotguns and, 36 Lines of Care Magnetic resonance angiography 1st Line and, 536 (MRA), neck injury and, infection and, 536 221–222 2nd Line and, 536 Magnetic resonance imaging (MRI) 3rd Line and, 536 ballistic trauma and, 466 battlefield and, 535–536 PHI and, 335 Liver injury, 314–317 spinal cord injury and, 350 hepatic artery ligation and, 316 Major Incident Management training, hepatic tractotomy and, 316 150 ICRC hospital and, 559–560 Major Incident Medical Management management of, 314–315 and Support Course angiography and, 316 (MIMMS), 493 embolization and, 316 ALSG and, 140 fibrin glue, 316 Malnutrition, Sarajevo siege and, 569 finger fracture in, 316 MAP. See Mean arterial pressure hepatic artery ligation and, 316 Massacres, reporting framework for, inflow occlusion in, 315 128–131 648 Index

Massive hemorrhage, mortality and, Mines, genitalia and, 272–273 180 Ministry of Health, hospital assessment Massive hemothorax, thoracic wounds and, 515 and, 246 Missiles Massive transfusion, protocols, 160 non-penetrating, 69 MCP joints, fractures and, 374 penetrating Mean arterial pressure (MAP), blast energy and, 69 and, 53 personal armor and, 67 Mechanical ventilation, nosocomial stopping, 69 pneumonia and, 458–459 Missiles emboli, 254 Median sternotomy, children and, 408 Missile wounds, distribution of, 586 Mediastinal sepsis, intra abdominal Missing people, reporting framework esophagus injury and, 309 for, 128–131 Medical equipment. See also MIST system, 498 Diagnostic equipment MLRS. See Multiple Launch Rocket DC and, 189 Systems prehospital environment and, 140 MODS. See Multiple-organ dysfunction Medical orders, 524 syndrome Medical treatment facility (MTF), Morbidity triage and, 529, 530, 531, 532 bladder injury and, 291 Mental disorders, post traumatic, blast injury and, 54 variables in, 602–605 firearms and, 6 Mental health pancreas injury and, 313 postcombat outcomes and, 602–605 Mortality survivors and, 602 abdominal GSWs and, 300 Metallized explosives, 47 bladder injury and, 290 burns and, 442 blast injury and, 54 Methane report, 141 DC surgery and, 182 Methylprednisolone duodenum injury and, 311 children and, 403 esophageal injury and, 262 spinal cord injury and, 352 firearms and, 6 METI human patient simulator, 492 GSWs and, 13 Mexico, firearms in, 15 larynx and, 224 Microscopic examination, GSWs and, liver injury and, 316, 317 104 massive hemorrhage and, 180 Military environment pancreas injury and, 313 abdominal GSWs and, 321 PHI and, 343 ballistic injury and, surgical thoracic wounds and, 242–243 procedures and, 178 MRA. See Magnetic resonance PHI and, 325 angiography Military first responder, 494–495 Multiple Launch Rocket Systems Military helmets. See Helmets, ballistic (MLRS), 61 Military injury, civilian injury v., Multiple-organ dysfunction syndrome 359–360 (MODS), 458 Military personnel, wounding missiles ICU and, 459 and, 70 Multisystem injury, triage and, 66 MIMMS. See Major Incident Medical Muscle, wound excision and, 171–172 Management and Support Muscle group injury, wound surgery Course on, 550–551 Index 649

Musculoskeletal system, blast injury laryngotracheal evaluation, 224–225 and, 55–56 mortality, 210 Musculoskeletal trauma, vascular NGO environment and, 560, 561 procedure and, 389 operative approaches to, 225–226 Myelography, spinal cord injury and, penetrating, 209 350 physical examination and, 219 Myocardial ischemia, hypothermia and, trajectory determination and, 455 216–218 vascular examination and, 218 N Nephrectomy Nasogastric feeding, burn injury and, nonoperative management and, 276, 438 277 Nasogastric tube penetrating renal injuries and, 273 burn injury and, 437 Nerves, wound excision and, 172 spinal cord injury and, 353 Neurogenic shock, 350 National Rifle Association, firearm Neuroimaging, PHI and, 333, 334, 335 regulation and, 19 Neurological function, vascular injury National Trauma Management Course and, 382–383 (NTMC), 489, 490 Neurologic examination NATO. See North Atlantic Treaty neck and, 214 Organization spinal cord injury and, 349 Near contact wounds, 101 Neurologic status, spinal cord injury Neck and, 354 airway and, 213–214 New England Journal of Medicine, anatomy of, 210–213 murder rates comparison and, assessment of, 213–218 12 breathing and, 214 NGOs. See Nongovernmental DC and, 205 organizations gunshot in, 156 NIBP. See Noninvasive blood pressure hemorrhage and, 214 Nitrous oxide, Lebanese civil war and, knife injury and, 155 586 spinal cord injury and, 354 Nongovernmental organizations surgeon challenges of, 621–623 (NGOs), 18–19, 20, 512 zone 1 injury of, 226 ballistic injury management in, zone III injury of, 228 541–564 zone II injury of, 226–228 hospital assessment and, 515 zones of, 212, 213, 391, 392 hospital environment in, 543 penetrating injury and, 468, 469 refugee camp surgery and, 585 Neck trauma, 209–240 Nongovernmental organizations angiography and, 218–219 (NGOs) field hospital carotid artery and, 228–233 abdominal injury and, 555–559 CFD and, 221 anesthesia, 549 children and, 402–404 antibiotics and, 548–549 CTA and, 220–221 casualty transfer and, 563–564 endovascular stents and, 233 DC in, 548 esophagography and, 223–224 diagnostic equipment in, 548 esophagoscopy, 223–224 endemic diseases and, 544 history of, 209–210 environment in, 543 investigation of, 216 extremity fractures and, 554–555 650 Index

Nongovernmental organizations Open pneumothorax, thoracic wounds (NGOs) field hospital (cont.) and, 245–245 OR in, 544 Operating room (OR) patient characteristics in, 545 DC surgery and, 182 penetrating wounds in, 548–549 NGOs field hospital, 544 postoperative care and, 563–564 Operating room (OR) thoracotomy, prehospital care in, 545 ERT v., 614 surgery in, 545 Operating theater, 524 surgical management in, 550–563 Operational analysis tools, 73 amputations and, 552, 554 Operation Just Cause, wounds and, 60 wound surgery and, 550–552 Operative dressing, wound surgery triage in, 546–547 and, 551 vascular injury and, 554–555 Oral fluid therapy, mass casualty Noninvasive blood pressure (NIBP), scenarios and, 443 anesthesia and, 163 Orders process, 147 Non-permissive environment, Organic psychiatric problems, ballistic treatment in, 142 injury and, 602 No-reflow phenomenon, vascular injury Organization for Security and and, 382 Cooperation in Europe, 20 North America, firearms damage and, 9 Organization of American States North American Trauma Center study, (OAS), 20 ERT and, 251 Organ repair North Atlantic Treaty Organization definitive reconstruction and, (NATO), 73 201–204 BABT and, 87 war surgery and, 558 PHI and, 327 OR. See Operating room spinal cord injury and, 354 Orthopedic(s) war surgery and, 537 DC and, 204 Nosocomial pneumonia, 458 injury mechanical ventilation and, 458–459 Lebanese civil war and, 587 NTMC. See National Trauma tertiary survey and, 452 Management Course Osteotomy, vascular injury, 392 Nursing care, 524 Ottawa Convention, antipersonnel spinal cord injury and, 353 mines and, 45 Nutrition Ovary injury scale, 322 ICU and, 360–361 Overpressure, thoracic injury and, pin tract infection and, Sarajevo 51 siege and, 571, 572 Oximetry, burn injury and, 435 Oxygen-carrying blood substitutes, O NGOs field hospital and, OAS. See Organization of American 549 States Oxygen saturation, burn injury and, Oblique iliac fossa incision, inguinal 427 ligament and, 576, 578 Ocular injury, NGO environment and, P 561, 562 Packaging, prehospital care and, 149 Open abdomen Packed red blood cells, ICU and, 449 ICU and, 455–456 Packing, vertebral artery and, 232 management of, 455–456 PAC. See Pulmonary artery catheter Index 651

Pain resuscitation in, 330 ICU and, 449 surgical management of, 340–341 spinal cord injury and, 354 Penetrating injury, 215–216 Palestinian refugee camp, surgery in, cervical spine and, 143 585–591 misguided information and, 613 Pancreas injury, 312–314 Penetrating limb injuries, 596 contusion in, 313 Penetrating renal injuries, 272–282 management of, 312, 313 associated injuries to, 282–283 NGO environment and, 559 clinical findings in, 273 Pancreas injury scale, 329 complications from, 283 Pancreatectomy, pancreas injury and, diagnosis of, 273 313 kidney organ injury scoring system Paralysis, ICU and, 450 and, 275 Partial nephrectomy, technique of, 282 laboratory findings in, 273 Partial thromboplastin time (PTT), nonoperative management of, 187 274–277 Pathologist, forensic, trauma personnel operative management of, 278–282 and, 91 outcomes from, 283 Patient self management, austere radiological findings in, 274–275 conditions and, 590 Penetrating trauma, 614 PBO. See Poly Cp-phenylene-2,6- blunt injury v., 612 benzobisotazole tracheal compression and, 155 Pediatrics, austere environments and, Penetrating ureteral injuries, 283–284 583 associated injury with, 284 PEEP. See Positive end expiratory clinical findings in, 284 pressure Penetrating wounds, 330, 331 Pellet colic, 272 Africa case study and, 594 Pelvic fracture anatomical distribution of, 539 austere environments and, 581, 582 groin and, 576–578 high riding prostate and, 607 Penicillin, NGOs field hospital and, Pelvic gunshot, peritonitis and, 621 548 Pelvic injury, DRE and, 606 Penile injuries, surgery and, 292 Penetrating abdominal wounds, Penis, amputated, reimplantation of, Hospital Sarajevo, 573 293 Penetrating chest injury Penis injury scale, 337 CT and, 475 Penrose drain, genital injuries and, 293 Lebanese civil war and, 587 Pepper pot wounds, Lebanese civil war management of, 264 and, 589 Penetrating genitourinary trauma, %TBSAB. See Percentage total body mechanisms of, 270–273 surface area burned Penetrating head injuries (PHIs), Percentage total body surface area 325–347 burned (%TBSAB) CT of, 350 burn injury and, 426, 429, 437 EMS and, 330 Lund and Browder chart for, 434 GCS score and, 333, 343 mass casualty scenarios and, 443 injury classification in, 327–328 rule of nines for, 433 postoperative care for, 341–342 Perforating wounds, 98, 330, 332 preoperative treatment for, 335–340 Perforation, delayed, blast injury and, prognosis for, 342–344 54 652 Index

Pericardiocentesis, thoracic wounds Pistols and, 247 ammunition for, 39 Pericardium history of, 32, 33–34 FAST and, 481 Plaster, fractures and, 369, 379 hemorrhage and, 252, 253 Plastic surgery team, austere Peripheral pulses, vascular injury and, environments and, 583 382 Platelet function, hypothermia and, Peripheral vascular organ injury scale, 187 337 Plates, fractures and, 370, 371 Peritoneum, groin and, 576, 578 Pledgets suturing, heart and, 594 Peritonitis Pneumatic tourniquet, wound surgery fistulas and, 321 and, 552 pelvic gunshot and, 621 Pneumonectomy, lung injuries and, Periureteral retroperitoneal drainage, 259–260 ureteral reconstruction and, Pneumothorax, chest tube insertion 286 and, 249 Permanent cavity, 41 PoA. See Program of Action projectile and, 95, 96 Police body armor. See Combat body Permissive environment, casualties armor condition and, 143–144 Police officers, BABT and, 84 Persian Gulf War, 84 Poly Cp-phenylene-2,6-benzobisotazole Personal armor (PBO), 73 materials for, 73 helmets and, 77 protection test and, 71 Polytetrafluoroethylene (PTFE) grafts, threats and testing of, 71 carotid artery injuries and, types of, 76 231 PE. See Pulmonary embolism Polytetrafluoroethylene (PTFE) pH, ICU and, 454 prosthesis, vascular injury Pharyngeal evaluation, neck injury and, and, 384 222–224 Poly-trauma, vascular injury and, 382 PHIs. See Penetrating head injuries Popliteal artery, vascular injury and, Phosphorus, burns and, 442 391 Phrenic nerve, 211 Positive end expiratory pressure Physical examination (PEEP) ballistic injury and, 465 blast injury and, 52 bullet wound and, 623–624 ICU and, 450 penetration injury and, 445, 446 settings, 462 vascular injury and, 382 Postcombat, mental-health outcomes Physician, emergency room and, 603 forensic medicine and, 91 Postcombat mental disorder, PTSD v., gunshot wound documentation and, 603 93 Postoperative care Pinnard’s stethoscope, 421 NGO field hospital and, 563–564 Pins. See also Bicortical pin placement PHIs and, 341–342 external fixator, foot and, 376 Postoperative meningitis, signs of, 342 limb injury and, 373 Post-trauma mental illness, 604, 605 thigh and, 376 Post-traumatic stress disorder (PTSD), Pin tract infection, nutrition and, 7, 55 Sarajevo siege and, 573, 572 postcombat outcomes and, 603 Index 653

Powder tattooing, 102 Projectile defeat intermediate range wounds and, 102, armor system and, 74 103 ceramic and, 76 Pre-deployment, health care personnel mechanisms for, 73–76 and, 579 Projectile-tissue interaction Pregnancy wounds and, 41–42 assessment and management during, wounds of, mechanism of injury in, 419 41–44 breathing and, 419 Prostate gland, high riding, 607 cervical spine and, 419 DRE and, 607 circulation and, 419 Prosthetic interpositional graft, ballistic injuries in, special hemorrhage and, 191–192 considerations of, 422 Protection test, personal armor and, ballistic injury during, 418–423 71–72 obstetric intervention and, 421–422 Protective armor penetrating maternal trauma and, Casualty Reduction Analysis model 414–415 and, 72 respiratory system and, ballistic yarns and, mechanisms of, 74 trauma and, 419 Prothrombin time (PT), 187 Rhesus antibody negative mother Prothrombin time/partial and, 422 thromboplastin time surgical intervention and, 421–422 (PT/PTT), 332 Pregnant abdomen, assessment of, 421 Protocol against Illegal Manufacturing Prehospital care of and Trafficking of Firearms, ballistic casualty and, 137–150, 146 Their Parts, Components and blunt injury and, 611 Ammunition, 18 Prehospital care provider, 148 Pseudoaneurisms, PHIs and, 340 Prehospital environment Pseudo-gunshot wound, 109 arriving at scene in, 140 Pseudo-powder tattoo, 107, 108 clothing in, 138–140 Pseudo-soot blackening, 107, 108 cricothyroidotomy and, 157 Psoas hitch maneuver, 289 medical equipment in, 140 P (priority) system, triage and, 528, preparation for, 138 531 scene assessment in, 141–142 PTFE grafts. See training for, 138 Polytetrafluoroethylene trauma resuscitation in, 492–494 (PTFE) grafts zones of care in, 139 PT/PTT. See Prothrombin time/partial Prehospital Trauma Life Support thromboplastin time Manual, 494 PTSD. See Post-traumatic Stress Pressure areas, spinal cord injury and, Disorder 354 PT. See Prothrombin time Pressure differentials, alveoli and, 51 PTT. See Partial thromboplastin time Presurgical care, infection and, 168 Public health Primary blast injury, 45 armed violence and, 132 pathophysiology of, 51 ballistic trauma and, armed violence Pringle maneuver, liver injury and, 315 results and, 124–127 Priority system. See P system small-arms and, 3 Proforma, forensic evaluation and, 92 Pulmonary artery catheter (PAC), 186 Program of Action (PoA), 18, 19 ICU and, 449 654 Index

Pulmonary contusions Refugee camps blood-brain barrier and, 187 firearms damage and, 8 high energy rounds and, 85 surgery in, 585–591 Pulmonary embolism (PE), spinal cord Regulations, hand-gun, 22 injury and, 353 Rehabilitation Pulmonary hilum twist, DC and, 205 NGO field hospital and, 563–564 Pulse oximeter spinal cord injury and, 354 burn injury and, 427 Renal injury ICU and, 449 NGO environment and, 560 Pupillary exam, PHIs and, 343 penetrating, SGW and, 270 Renal pedicle Q left visceral rotation and, 279 Quality assurance, blunt injury and, 612 right visceral rotation and, 279 Renal vascular injuries, WTA and, 280 R Renorrghaphy Radial artery, vascular injury and, 390 kidney and, 279 Radiographs technique of, 281 abdominal GSWs and, 301 Repatriation, critical care transfer team ballistic injury and, 377–378 and, Iraq conflict and, 597 penetration injury and, 445 Repeating firearms, development of, 31 Radiopaque markers. See also Wound Reperfusion injury, ischemia and, 382 markers Resection children and, 404 pancreas injury and, 314 Radio-programmed grenade (RPG), small bowel injury and, 318 45 stomach injury and, 310 Range of fire, 98 Respiratory system, pregnancy and, 419 Reactive surround explosives, 47 Resuscitation. See also Hypotensive Recombinant factor VIIa (rFVIIa), resuscitation 166 ATLS/BATLS guidelines and, 161 abdominal GSW and, 307 ballistic casualty and, 151–167 blast-injured casualties and, 65 clinical principles in, 152, 153 DC II and, 198–199 forensic evaluation and, 92 Recombinant human activated protein ICU and, 448, 449 (Xigris), septic shock and, 460 Iraq conflict and, 597 Rectum pregnancy, ballistic injury and, 419 abdominal GSWs and, 319–320 preparation and, 151 failure to evaluate, GSW and, 622 trauma practitioner and, 487–488 NGO environment and, 559 trauma teams and, 151–152 Rectum injury scale, 331 activation and, 152 Red Crescent emblem, hospital Resuscitation area, imaging away from, protection and, 518 467 Red Crescent Societies, 518, 519 Resuscitative endpoints, 164 Red Cross, 518, 519. See also Resuscitative thoracotomy (RT), International Committee of children and, 406–407 Red Cross Retained ordinance, injury and, 65 hospital assessment and, 515 Retrograde urethrogram (RUG), 292 hospital protection and, 518 Retroperitoneal hematomas triage and, 528 abdominal GSWs and, 320 weapons laws and, 17 anatomic zones of, 271 Index 655

Revascularization, vascular injury and, Security Council Resolutions, firearms 413, 414 and, 17 Revised Trauma Score, triage Seizures, PHIs and, 340 methodology and, 533 Selective conservatism, nonoperative Revolvers management and, 276 double action, 32, 33–34 SEM-EDX. See Scanning electron history of, 32, 33–34 microscope-energy dispersive single action, 32, 33–34 X-ray spectrometry rFVIIa. See Recombinant factor VIIa Semi-permissive environment, Rhesus antibody negative mother, 422 treatment in, 142–143 pregnancy and, 422 Semtex, 46 Rifle(s) Sepsis, ICU and, 459 7.62 millimeter NATO, 43, 44 Septic shock, recombinant human AK-47, 42 activated protein and, 460 ammunition for, 39 Serial halving, burns and, 433 history of, 32, 35, 36 7.62 millimeter NATO rifle, 43, 44 M-6A1, 43 Shear waves, 51 military bullets, NATO and, 87 Shock, DC pathway and, 185 semiautomatic, 32, 35, 36 Shooters, emotional components of, Right visceral rotation, 280 599–601 Rigid ceramic plate, 81 Shotguns, 36, 38, 272. See also armor and, 74 Ammunition; Rifle(s) projectile defeat and, 76 combat, 36 removal of, 89 injuries from, 177–178 Rocket propelled grenades (RPGs), sawed-off, 36 84 Shrapnel, 272 Roma Plastilina, 86 challenges of, 614 RPG. See Radio-programmed grenade CT of, 339 Rubber bullets, 40 Shunt(s) carotid artery, 389 S heparin-bonded, carotid artery SADC. See South Africa Development injuries and, 230 Community intravascular, DC and, 192 Saphenous grafts, PTFE grafts v., 231 vascular, carotid artery injuries and, Saphenous vein, PTFE prosthesis and, 228, 230 384 SICU. See Surgical ICU Sarafix, Sarajevo siege and, 572 Sieve triage algorithm, 531, 532 Sarajevo siege Signals and Commands, 148 ballistic missile injuries in, 569–575 SIRS. See Systemic inflammatory civilian v. military casualties in, 569, response syndrome 570 SirUS. See Superficial Injury and lessons learned from, 574–575 Unnecessary Suffering Project Scanning electron microscope-energy Situation report, 148 dispersive X-ray spectrometry Skeletal muscle, ballistic injury and, (SEM-EDX), 109, 114 381 SCM. See Anterior sternocleidomastoid Skin, exit wounds and, 106 Scoop nephrectomy, 278 Skin excision, excessive, 169–170 Scrotal injuries, 292 Skin flap, 356, 359 Scrotum injury scale, 337 hand and, 374 656 Index

Skin grafting Spinal Injury Association form, ICU NGO environment and, 561, 562 and, 446 repair, 384, 385 Spinal shock, 350 Skin pressure, ICU and, 446 Spleen injury, 317–318 Small arms austere environments and, 580, 581 history of, 32, 33 NGO environment and, 558 interventions and, 18 Spleen injury scale, 328 legal v. illegal use of, 14–18 Splints. See also Thomas splints public health approach to, 3–30 ICU and, 446 Small Arms Survey SQ heparin. See Intermittent firearms and, 5 subcutaneous heparin firearms value and, 14 Stab wounds Small bowel injury genitourinary system and, 270 abdominal GSWs and, 318 penetrating renal injuries and, 282 NGO environment and, 559 thoracic great vessel injuries and, Small bowel injury scale, 331 255–257 Society, firearms in, 5 Staphylococcus, PHIs and, 340 Soft point rifle bullets, 39, 97 Staphylococcus aureus, VAP and, 458 Soft tissue injury, 373 Static mines, 61 debridement in, 170 Stellate wounds, 99, 100 Lebanese civil war and, 586 Stent-graft placement, thoracic great projectile and, 95 vessel injuries and, 256 Sarajevo siege and, 573 Sternocleidomastoid muscle, 212 treatment goals with, 168 Sternotomy, thoracic great vessel Solid organ injury, blast injury with, 55 injuries and, 256 Somalia, 84 Steroids, spinal cord injury and, 352, Somatic problems, 605 353 SoNoSite, 481 Stomach injury Soot disposition, intermediate range incidence of, 310 wounds and, 102 management of, 310 South Africa Development Community NGO environment and, 558 (SADC), 20 outcome of, 310 South America, gun-related deaths Stomach injury scale, 330 and, 10–11 Stomas, abdominal GSWs and, 321 Spermatic cord, hematomas in, 293 Streptococcal infections, burn injury Spinal cord injury, 215, 348–355 and, 441 abdominal GSWs and, 301 Streptococcus, PHIs and, 340 antibiotics and, 352–353 Streptococcus pneumoniae, VAP and, children and, 403 458 imaging and, 350–351 Subarachnoid hemorrhage, 338 instability and, 350 PHI and, 335 investigations of, 350 Subclavian arteries, carotid artery management and assessment of, injuries and, 232 349 Subclavian artery injury, surgery for, military history of, 348 390–391 nursing care and, 353 Subclavian vascular injury, 256 pathophysiology of, 348 Suicide, 6, 13 surgery and, 350–351 Britain and, death rates in, 9–10 Spinal injury, tertiary survey and, 452 Wales and, death rates in, 9–10 Index 657

Superficial Injury and Unnecessary lateral chest injury and, 614, 615 Suffering Project (SirUS), 17 limb injury and, 361, 362 Supplies, hospital pediatrics and, 584 consumable PHI and, 340 drugs and, 521 Surgical ICU (SICU), advances in, 457 prepack dressing sets and, 521 Surgical wound care, 168–170 pre-sterilized, 521 Survival, cardiac injury and, 253 non-medical, 522 Survivors, ballistic injury and, 602 Support information, 148 SVR. See Systemic vascular resistance Surgeon(s). See also Field surgical Swelling, foot and, 376 teams; Forward surgical teams Systemic inflammatory response abdomen and, 617, 619–621 syndrome (SIRS) attributes of, ballistic trauma airway burn and, 426 management and, 488 burns and, 438, 441 blunt injury and, 611 ICU and, 459–460 decision making and, 624 surgical debridement, 441 deployment and, 580 Systemic vascular resistance (SVR), routine accident scenarios and, 200 580–583 lateral chest injury and, 614 T military, civilian surgery training v., TABS. See Trauma attenuating 497 backings NGO field hospital and, 563 Tactical Combat Casualty Care Course potential errors for, 622 (TCCC), 494 pre-deployment and, 579 Tactical Field Care, 137, 148 kit list and, 579 semi-permissive environment and, Surgery. See also Surgical debridement; 138 War surgery Tangential wounds, 328, 329 austere environments and, 586 Task, 148 DC and, 204 TBI. See Traumatic brain injury injury types in, Lebanese civil war TEG. See Thromboelastogram and, 587 Tempanic membrane, blast injury and, limb injury and, 361 54 amputation and, 362 Temporal lobes, pediatric head injury wound closure and, 363–364 and, 401 military environment and, ballistic Temporary cavity, 41 injury and, 178 projectile and, 95, 96 military trauma training in, 497–498 tissue and, 96, 98 NGOs field hospital and, 547–548 Tendons, wound excision and, 172 positioning for, abdominal GSWs Tension pneumothorax, thoracic and, 303–304 wounds and, 244 preparation for, abdominal GSWs Terminal ballistics, wound ballistics v., and, 303 94 refugee camps and, 585–591 Tertiary survey, 624 spinal cord injury and, 350–351 DC II and, 199–200 wound management after, 173 factors confounding, 447 Surgical debridement, 113, 169, 170 injuries missed in, 451 burns and, 441 abdomen and, 451 forearm and, 374 combined injury and, 452 658 Index

Tertiary survey (cont.) delayed, 252 orthopedic and, 452 early, 251 spine and, 452 Thorax thorax and, 451 fragment wounding and, 60 vascular and, 452 personal armor and, 76 Testes, penetrating injury and, 293 tertiary survey and, 451 Testes injury scale, 322 Thromboelastogram (TEG), anesthesia Test firing, forensic ballistic and, 164 laboratories and, 103 Through-and-through injury, ballistic Tetanus, abdominal GSWs and, 303 injury with, 622 Tetanus prophylaxis, NGOs field Thyroid cartilage, 210 hospital and, 548 Tibial artery, vascular injury and, 391 Textile armors, bullet perforation and, TICA. See Traumatic intracranial 88 aneurysms Thermal blast, injury with, 56 Time, 148 Thermobaric, 47 Tissue Thigh, fasciotomy of, 176 bullet energy and, 41 Thomas splints, austere environments damage, KE transfer and, 97 and, 580 wounds and, 373 Thoracic bullets and, 44 armor, 83 Tissue injury. See Soft tissue injury duct injuries, 263 TMGSW. See Transmediastinal gunshot great vessel injuries, 255–257 wounds management principles of, 255 TNT. See 2,4,6-trinitrotuluene impalements, 263 Torso armor injury, 241–269, 404 ballistic, 79–80 children and, 404 knives and, 81–83 historical perspective of, 241–242 Tourniquets, limb injury and, 364 low-velocity handgun and, 614 Toxicities, wounding with, 59 NGO environment and,560 Trace evidence, 113 overpressure and, 51 Tracheal, 210 Thoracic access compression, penetrating trauma children and, 407–408 and, 155 incisions for, children and, 407–408 injury, 235 Thoracic vascular injury scale, 327 wounds, NGO environment and, Thoracic wounds 561 airway obstruction and, 243 Tracheobronchial injuries, 258–259 cardiac tamponade and, 244–245 Tracheobronchoscopy, DL and, 225 chest tube insertion and, 248–249 Tracheolaryngeal wounds, repair of, diagnostic adjuncts with, 247–248 234–235 initial assessment of, 246 Tracheostomy, neck GSW and, 235 open pneumothorax and, 245–245 Track tamponade, liver injury and, 316 pathophysiology of, 242–243 Traction, fractures and, 369–370 tension pneumothorax and, 244 Traction pins, austere environments Thoracoabdominal injuries, 262–263 and, 580 management of, 614 Tractotomy, liver injury and, 316 NGO environment and, 560 Training. See also Ballistic trauma Thoracoscopy, children and, 406 training; Computer-generated Thoracotomy, indications for, 249–252 training environment; children and, 406–407 Definitive Surgical Trauma Index 659

Care course; Gulf War; Major training, virtual reality and, 498–499 Incident Management Trauma attenuating backings (TABS), training; Prehospital soft armors and, 85 environment; Prehospital Trauma centers, civilian, PHI and, 325 Trauma Life Support Manual; Trauma laparotomy, 305–306 Surgery; Virtual reality abdominal wounds and, 299 prehospital care and, 149–150 contamination in, 306 trauma, virtual reality and, 498–499 hemorrhage control in, 305 Trajectory, abdominal GSWs and, 301 systematic exploration in, 305 Transcervical gunshot wounds (GSWs), Trauma resuscitation 622 ICU and, 447 neck and, 216, 217 prehospital environment and, Transfer 492–494 austere conditions and, 593 simulations, 492 repatriation and, Iraq conflict and, video review of, 490, 491 597 Trauma surgeon. See Surgeon spinal cord injury and, 354 Traumatic brain injury (TBI), bombing Transfusion. See also Massive and, 55 hemorrhage; Massive Traumatic brain injury (TBI), transfusion nonpenetrating, PHI v., 342 abdomen and, 617 Traumatic intracranial aneurysms Transmediastinal gunshot wounds (TICA), PHIs and, 340 (TMGSW) Triage, 527–539, 528–529 mortality and, 258 burn injury and, 424 surgery indications for, 616–617 considerations in, 529–530 Transmediastinal injuries, 258 casualty-related factors in, 530 imaging for, 472–475 extraneous factors in, 529–530 Transmural injury, blast injury and, historical overview of, 527–528 54 multisystem injury and, 66 Transureteroureterostomy, 287 NGOs field hospital and, 546–547 Transverse (collar) incision P systems and, 528–529, 531, 532 children and, 404 Revised Trauma Score and, 533 neck injury and, 227 tiered approach for, sieve algorithm Trap door sternotomy, 226, 257 in, 531 Trauma, 604 Triage groups, scores converted to, activation criteria, 153 533 BABT and, 86 Trimethoprim-sulphametoxazole, fellowships in, 496–497 NGOs field hospital and, 548 management, decisions in, 228–240 2,4,6-trinitrotuluene (TNT), 46 personnel, bullet forensics and, 95 202 Field hospital practitioner intensive care unit and, 598 attributes of ideal, 487 war injuries and, 596–605 definitive care and, 495 Two-layer closure, duodenum injury resuscitation and, 487–489 and, 312 teams ballistic injury and, 422–423 U DC-Ground Zero and, 188 UCR. See Uniform Crime Reporting resuscitation and, 151–152 codes thoracic, 53 UHMWE. See Ultra-High Molecular mortality from, 83 Weight Polyethylenes 660 Index

Ulner artery, vascular injury and, 390 Urinomas, penetrating renal injuries Ultra-High Molecular Weight and, 283 Polyethylenes (UHMWE), 73 Urological care, spinal cord injury and, helmets and, 77 354 Ultrasound USS, High Dependency Unit care, abdominal GSWs and, 476–477 austere environments and, 581 portable, austere environments and, Uterus, ballistic injury and, 418–423 580 Uterus injury scale surgeon performed nonpregnant, 335 chest injury and, 472 pregnant, 335 thoracic wounds and, 247 Unexploded ordinance V

injury and, 65–66 V50 curve, armor system and, 71, 72 removal of, 66 Vacuum pack closure, ICU and, 462 Uniform Crime Reporting (UCR) Vagina injury scale, 336 codes, firearms morbidity and, VAP. See Ventilator-associated 6 pneumonia United Nations Vascular clamp investigations and, 129 austere environments and, 582 weapon regulations and, 17–18 hemorrhage and, 191 United Nations Convection on Vascular examination, neck injury and, Transnational Organized 218 Crime, 18 Vascular injury, 381–393 Universal Declaration of Human abdominal GSWs and, 320 Rights, 18 angiography in, 411–412 Urban warfare, 45 axillary artery in, 390–391 Ureter bleeding and, preoperative control abdominal GSWs and, 320 of, 383–384 classification of, 284–285 brachial artery in, 390–391 repair, gunshot and, 287 carotid artery and, 391–392 Ureteral children and, 416 reconstruction, 286–287 diagnosis of, 382–383 periureteral retroperitoneal groin and, 576–578 drainage and, 286 management of, 172 reimplantation, 288 children and, 412–413 Ureteral injury, immediate neck and, 622 management of, 285–286 neck zones and, 391–392 Ureteric organ injury scoring system, NGOs field hospital and, 554 285 operative management of, 384–390 Ureter injury scale, 334 popliteal artery and, 391 Ureteroureterostomy, 286 revascularization and, 413, 414 Urethra, NGO environment and, 559 subclavian artery injury in, 390–391 Urethra injury scale, 334 tertiary survey and, 452 Urethrography, austere environments tibial artery and, 391 and, 581 vertebral artery and, 393 Urinary bladder, NGO environment Vascular shunt, carotid artery injuries and, 559 and, 228, 230 Urinary drainage, ICU and, 446 Vasospasm, 413 Urine output, crush injuries and, 165 VAT. See Video-assisted thoracotomy Index 661

Vein grafts, vascular injury and, 388 War syndromes, postcombat outcomes Velocity, 270 and, 603 Ventilation, anesthesia and, 164–165 Weapons-collection programs, 21 Ventilation perfusion (V/Q) mismatch, Weapons, major, classifications of, 50 52 Weapons, transfers, 15 thoracic wounds and, 243 Weapon wounded, health-care system Ventilator-associated pneumonia assessment and, 513–516 (VAP) Western Trauma Association (WTA), ICU and, 458 renal vascular injuries and, prevention strategies for, 458–459 280 Ventricular septal defect (VSD), Whipple procedure, pancreas injury cardiac trauma and, 253 and, 313 Vertebral artery Whitman Patch, fascial closure and, bleeding of, control of, 232–233 202, 203 vascular injury and, 393 WHO. See World Health Organization Vertical incision, groin and, 577 Women, firearms damage and, 8 VHIS. See Vietnam Head Injury Working patterns, pre v. postwar, Study Sarajevo patients and, 574 Victims of War, austere conditions and, World Bank, NGOs and, 541 589–590 World Health Organization (WHO) Video-assisted thoracotomy (VAT), arms costs and, 6 thoracotomy and, 252 violence and, 124, 125 Vietnam Head Injury Study (VHIS), World War I, PHI and, 340 PHI and, 326, 340 World War II Vietnam war, high energy round and, PHI and, 326 indirect effect of, 85 surgery in, 497 Virtual reality, trauma training and, wounds in, 83 498–499 Wound(s). See also Abdominal gunshot Visible Human project, 498 wounds (GSWs); Close-range Vital signs, ICU and, 438 wounds; Contact wounds; Vitamin C, MODS and Entrance wounds; Hard- Volume resuscitation, pediatric trauma contact wounds; Incomplete and, 499 contact wounds; Intermediate VQ mismatch. See Ventilation range wounds; Limb injury; perfusion mismatch Limb wounds; Loose-contact VSD. See Ventricular septal defect wounds; Near contact Vulva injury scale, 336 wounds; Penetrating wounds; Perforating wounds; Soft W tissue injury; Stab wounds; War surgery, 542 Surgical wound care; field surgery and, 538 Tangential wounds; Lebanese civil war and, 585–591 Thoracic wounds limited resources in, 585 abdominal GSWs and, 303 medical facilities in, roles 1–4 in, arterial injury and, operative 536–537 management of, 384–390 NATO and, 537 ballistics post war humanitarian aid and, 575 forensic aspects of, 95–98 surgical management, general terminal ballistics v., 94 principles of, 538–539 burns and, 442 662 Index

Wound(s). (cont.): projectile-tissue interaction and, care, First Line, 535 41–44 civilian setting and, 173 mechanism of injury in, 41–44 closure, limb injury and, 363–364 Sarajevo siege and, 571 demographics of severity of, bullets and, 41 age and, 572 soft tissue, limb injuries and, 356, 357 effects in war of, 539 surgical debridement and, 169, 170 descriptions tangential, 328, 329 gunshot and, 117 vascular injury and, 381 records and, 117 World War II and, 83 distribution of, 69, 70 Wounding distribution of missile, 586 agents dressing, 172–173 distribution of, 71 entrance v. exit, 93 missile percentages as, 586 excision effect, KE and, 270 bones and, 172 missiles, military personnel and, 70 high energy transfer GSWs, 553 Wound markers (radiopaque markers), muscle and, 171–172 ballistic trauma and, 466 nerves and, 172 Wound to muzzle distances, 101, 102 tendons and, 172 wound surgery and, 551 X fragments and, 59 Xigris. See Recombinant human anatomical distribution of, 57 activated protein genital injuries and, 292 X-ray imaging irrigation, 172–173 burns and, 432 vascular injury and, 401 chest longitudinal skin incisions and, 550 GSW and, 473 low velocity, 60 thoracic wounds and, 247 management children and, 404–406 fasciotomy, 177 pelvic, DC-Ground Zero and, 188 post surgical, 173 spinal cord injury and, 350 margins, 106 military v. civilian, 359–360 Y NGOs field hospital and, 546 Yarns, protective armor and, primary closure and, 173 mechanisms of, 74