Preparing Japanese surgeons for potential mass casualty situations will require innovative and systematic programs

Treatment of a gunshot wound (birdshot) patient with traumatic shock in a hybrid emergency room

Background

Although the Hybrid Emergency Room System (HERS) is a relatively novel method for treating severe trauma patients, there have been few reported cases of gunshot wound patients treated in HERS. Here we report our treatment of a unique gunshot wound case, with shock, in a HERS setting.

Case presentation

A 72-year-old male was transferred to our hospital due to a gunshot wound (GSW). He presented with left chest injuries and vital signs consistent with shock. While resuscitating the patient, including massive blood transfusion and surgery to control the damage, a subsequent computed tomography in HERS revealed the internal distribution of the birdshot and damage to the abdominal organs. Lower lobectomy of the left lung and laparotomy for gastrointestinal repair were performed. After a planned repeat operation and reconstruction of the left chest wall, he was discharged uneventfully.

Conclusions

HERS during resuscitation was useful for helping clinicians not only to find the bullets' distribution and judge the severity of injury caused by the gunshot, but also to develop subsequent therapeutic strategies for rescuing the gunshot wound patient from a life-threatening situation.

War surgery in Afghanistan: a model for mass causalities in terror attacks?

PURPOSE

The aim of the study was to identify solution strategies from a non-governmental (NGO) hospital in a war region for violence-related injuries and to show how high-income countries (HIC) might benefit from this expertise.

METHODS

NGO trauma hospital in Lashkar Gah, Afghanistan. Four hundred eighty-four war victims admitted in a three month period (February 2016-May 2016) were included. Patients´ characteristics were analyzed.

RESULTS

The mean age was 23.5 years. Four hundred thirty-four (89.9%) were male, and 50 (10.1%) were female. The most common cause of injury was bullet injuries, shell injuries, and mine injuries. The most common injured body region was the lower extremity, upper extremity, and the chest or the face. Apart from surgical wound care and debridements, which were performed on every wound in the operation theatre, laparotomy was the most common surgical procedure, followed by installation of a chest drainage and amputation.

CONCLUSION

The surgical expertise and clear pathways outweigh modern infrastructure. In case of a mass casualty incident, fast decision-making with basic diagnostic means in order to take rapid measurements for life-saving therapies could make the difference.