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Management of limb injuries caused by weapons of war or explosions in an attack

Published in N°266 - August/September 2017
Article viewed 57 times

Management of limb injuries caused by weapons of war or explosions in an attack

By Sylvain Rigal in category UPDATE
Titulaire de la chaire de chirurgie del'Ecole du Val-de-Grâce. Hôpital d'Instruction des armées Percy Clamart.

On 14 November 2015, the front pages of French newspapers did not mince their words. Le Figaro ran a headline saying that “war” had come to the middle of Paris. Sud-Ouest thought that “France was at war”. Since the start of 2016, Europe has seen more than 25 terrorist attacks, five of which involved weapons of war or explosives. These attacks have brought injuries usually associated with warfare to the very heart of European cities.

What characterises hospital care during an attack?

A terrorist attack, by suicide bomb, can happen at any time and in any place, and often produces mass casualties. The proximity of the explosions, occurring in the busiest parts of bustling cities, means that “ground zero” is brought very close to the doors of hospital buildings themselves. One of the main consequences of this is a reduction in the time it takes for the first casualties to arrive. Those with the most serious injuries, however, are not necessarily the first to arrive in triage: making their own way to the hospital, with no prior care, some casualties with more minor injuries will add to the workload of emergency personnel. As a result, triage and shock units can be clogged up by patients with injuries that may be classed as relative emergencies. The hospital must be organised in such a way as to take this into account. As transport time is reduced (in comparison with textbook cases), those patients who – in another context – would be seen as dying or “beyond emergency care” can receive immediate resuscitation surgery.

The nature of this type of terrorist attack also has an impact on the way in which casualties are treated, as well as on how decisions to deal with emergency cases are made. Uncertainty over the...

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