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Abstract
OBJECTIVE Treating burn patients in the battlefield is one of the biggest challenges that military doctors and medical personnel can face. Wound patterns have been changed over time due to the introduction of new weapons, and many different aspects play a major role in the management of those burns nowadays. There is a potential gap in care of burn patients in war zones. METHODS A thorough literature search in PubMed, scientific journals, and Internet sites was conducted in regard to burn patients and trauma in war zones. RESULTS It is crucial for military surgeons to be able to stabilize burn patients during wartime conflicts, especially those patients who suffer from extreme burn injuries, as specialized treatment should be given. Medical personnel should be aware of all medication types used, the ways to minimize the risk of bacterial infection, and the ways to keep the injured safe. CONCLUSIONS Injured civilians with burn trauma in the field of battle are deserving care, and special recognition should be given to the non-governmental organizations (NGOs) that strive to ease human suffering in war zones. Proper management of burn patients in war zones is crucial, and military medical staff and NGOs can play a key role in that purpose.
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Guidelines for Burn Care Under Austere Conditions: Introduction to Burn Disaster, Airway and Ventilator Management, and Fluid Resuscitation. J Burn Care Res 2018; 37:e427-39. [PMID: 27224004 DOI: 10.1097/bcr.0000000000000304] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Angel J, Evans DP. 'Why are we not doing more for them?': genocide prevention lessons from the Kindertransport. Public Health 2017; 153:36-43. [PMID: 28822851 DOI: 10.1016/j.puhe.2017.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/11/2017] [Accepted: 07/07/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Genocide remains one of the most widespread forms of preventable mortality and morbidity for children today. Despite the creation of multiple human rights treaties, genocide has not been eliminated and its effects disproportionally impact children. The Kindertransport was a series of rescue efforts that brought thousands of refugee children to the United Kingdom from Nazi Germany between 1938 and 1940. This qualitative study asks what public health professionals can learn from the prevention efforts of the Kindertransport by examining the experiences and reflections of individuals rescued as children. The specific aims of the study were (1) to analyze qualitatively the impact of the rescue on rescued children; (2) to evaluate the strengths and limitations of the Kindertransport as a prevention effort; and (3) to draw implications for contemporary public health responses to global genocide. STUDY DESIGN Qualitative research study. METHODS In-depth interviews, using a semi-structured interview guide, were conducted with 27 survivors of the rescue. The data were thematically coded, and excerpts exported and interpreted in reflection of patterns and themes using Dedoose. RESULTS Five inductive themes emerged from the data related to the broad spectrum of antisemitic persecution: the breakup of families; integration in the UK via the Kindertransport; the challenges of adapting to a new environment; and the implications for global rescue efforts. CONCLUSIONS The results suggest that the public health community should act to prevent genocide through rapid intervention and rescue; at the same time, the effects of persecution must be addressed and sustained social, emotional, and psychological support must be provided to those rescued.
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Affiliation(s)
- J Angel
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - D P Evans
- Hubert Department of Global Health, Rollins School of Public Health and Institute of Human Rights, Emory University, Atlanta, GA, USA
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de C Williams AC, Baird E. Special Considerations for the Treatment of Pain from Torture and War. CURRENT ANESTHESIOLOGY REPORTS 2016; 6:319-326. [PMID: 27942252 PMCID: PMC5124052 DOI: 10.1007/s40140-016-0187-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pain care for survivors of torture and of war shows similarities and marked differences. For both, pain can be complex with unfamiliar presentations and the pains hard to assign to known disorders. For many survivors, pain and associated disability are overshadowed by psychological distress, often by post-traumatic stress symptoms that can be frightening and isolating. Pain medicine in war can exemplify best techniques and organisation, reducing suffering, but many military veterans have persistent pain that undermines their readjustment. By contrast, survivors of torture rarely have any acute health care; their risk for developing chronic pain is high. Even when settled as refugees in a well-resourced country, their access to healthcare may be restricted. Recent evidence is reviewed that informs assessment and treatment of pain in both groups, with the broader context of psychological distress addressed at the end. Clinical and research implications are briefly outlined.
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Affiliation(s)
- Amanda C. de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT UK
| | - Emma Baird
- Lancashire Teaching Hospitals NHS Foundations Trust, Sharoe Green Lane North, Fulwood, Preston, Lancashire PR2 9HT UK
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Stewart BT, Lafta R, Esa Al Shatari SA, Cherewick M, Burnham G, Hagopian A, Galway LP, Kushner AL. Burns in Baghdad from 2003 to 2014: Results of a randomized household cluster survey. Burns 2015; 42:48-55. [PMID: 26526376 DOI: 10.1016/j.burns.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 01/05/2023]
Abstract
PURPOSE Civilians living amid conflict are at high-risk of burns. However, the epidemiology of burns among this vulnerable group is poorly understood, yet vital for health policy and relief planning. To address this gap, we aimed to determine the death and disability, healthcare needs and household financial consequences of burns in post-invasion Baghdad. METHODS A two-stage, cluster randomized, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about cause of household member death, households were interviewed regarding burn specifics, healthcare required, disability, relationship to conflict and resultant financial hardship. RESULTS Nine-hundred households, totaling 5148 individuals, were interviewed. There were 55 burns, which were 10% of all injuries reported. There were an estimated 2340 serious burns (39 per 100,000 persons) in Baghdad in 2003. The frequency of serious burns generally increased post-invasion to 8780 burns in 2013 (117 per 100,000 persons). Eight burns (15%) were the direct result of conflict. Individuals aged over 45 years had more than twice the odds of burn than children aged less than 13 years (aOR 2.42; 95%CI 1.08-5.44). Nineteen burns (35%) involved ≥ 20% body surface area. Death (16% of burns), disability (40%), household financial hardship (48%) and food insecurity (50%) were common after burn. CONCLUSION Civilian burn in Baghdad is epidemic, increasing in frequency and associated with household financial hardship. Challenges of healthcare provision during prolonged conflict were evidenced by a high mortality rate and likelihood of disability after burn. Ongoing conflict will directly and indirectly generates more burns, which mandates planning for burn prevention and care within local capacity development initiatives, as well as humanitarian assistance.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Public Health, Kwame Nkrumah University, Kumasi, Ghana; Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Riyadh Lafta
- Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq; Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Megan Cherewick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gilbert Burnham
- Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy Hagopian
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Lindsay P Galway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
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Ademuyiwa AO, Usang UE, Oluwadiya KS, Ogunlana DI, Glover-Addy H, Bode CO, Arjan BVAS. Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge. J Emerg Trauma Shock 2012; 5:55-61. [PMID: 22416156 PMCID: PMC3299155 DOI: 10.4103/0974-2700.93114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 03/21/2011] [Indexed: 11/03/2022] Open
Abstract
All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.
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Affiliation(s)
- Adesoji O Ademuyiwa
- Department of Surgery, Pediatric Surgery Unit, College of Medicine, University of Lagos, Lagos, Nigeria
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Management of war-related burn injuries: lessons learned from recent ongoing conflicts providing exceptional care in unusual places. J Craniofac Surg 2011; 21:1529-37. [PMID: 20818237 DOI: 10.1097/scs.0b013e3181f3ed9c] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thermal injury is a sad but common and obligatory component of armed conflicts. Although the frequency of noncombat burns has decreased, overall incidence of burns in current military operations has nearly doubled during the past few years. Burn injuries in the military environment do not need to be hostile in nature. Burns resulting from carelessness outnumber those resulting from hostile action. Unfortunately, civilians are becoming the major targets in modern-day conflicts; they account for more than 80% of those killed and wounded in present-day conflicts. The provision of military burn care mirrors the civilian standards; however, several aspects of treatment of war-related burn injuries are peculiar to the war situation itself and to the specific conditions of each armed conflict. Important aspects of management of burned military personnel include triage to ensure that available medical care resources are matched to the severity of burn injury and the number of burn casualties, initial management and resuscitation in the combat zone, and subsequent evacuation to higher echelons of medical care, each with increasing medical capabilities. Care of military victims is usually well structured and follows strict guidelines for first aid and evacuation to field hospitals by military personnel usually having had some form of training in first aid and resuscitation and for which necessary equipment and material for such interventions are more or less available. Options available for civilian injury intervention in wartime, however, are limited. Of all pre-hospital transport of civilian victims, 70% are done by lay public and 93% receive in the field, or during transport, some form of basic first aid administered by relatives, friends, or other first responders not trained for such interventions. Civilian casualties frequently represents 60% to 80% of all injured admitted to the level III facilities of overseas forces stationed throughout the host country. Unlike military personnel who are rapidly evacuated to higher echelons IV and V for definitive and long-term care, civilians must receive definitive burn treatment at these level III military facilities. The present review was intended to highlight peculiar aspects of war-related burn injuries of both military personnel and civilians and their management based on the most recently published material that, for the most part, is related to the recent conflicts in Iraq and Afghanistan.
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Sethi D, Aljunid S, Saperi SB, Zwi AB, Hamid H, Mustafa ANB, Abdullah AHA. Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in malaysia. THE JOURNAL OF TRAUMA 2002; 53:508-16. [PMID: 12352489 DOI: 10.1097/00005373-200209000-00019] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effectiveness of trauma services provided by three hospitals operating at different levels of care, district general (DGH), tertiary care, and central tertiary, were compared in Malaysia. METHODS Cases were recruited prospectively for 1 month. Outcome measures included death or, among survivors, disability at discharge. RESULTS Leading causes of injuries were road traffic (72%), falls (9%), industrial (6%), and assaults (5%). Fifty-nine percent of cases were direct admissions and 41% were interhospital transfers. Of the 286 direct admissions, 12% arrived by ambulance and the remainder mostly by private car. For direct admissions, logistic regression identified an increased odds of dying associated with admission to DGH (compared with central tertiary) (odds ratio [OR], 9.8; 95% confidence interval [CI], 1.3-73.7), severe injuries (Injury Severity Score > 15) (OR, 33.1; 95% CI, 7.5-146.7), and older age (> or = 55 years) (OR, 10.8; 95% CI, 2.0-56.8). Disability at discharge was associated with being severely injured (OR, 6.4; 95% CI, 2.4-17.1). CONCLUSION In this study in Malaysia, admission to DGH, older age, and severe injuries are associated with increased odds of fatality.
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Affiliation(s)
- Dinesh Sethi
- London School of Hygiene and Tropical Medicine, England.
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Brennan RJ, Nandy R. Complex humanitarian emergencies: a major global health challenge. EMERGENCY MEDICINE (FREMANTLE, W.A.) 2001; 13:147-56. [PMID: 11482851 DOI: 10.1046/j.1442-2026.2001.00203.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Complex humanitarian emergencies have been a major political, security and public health feature of the post-Cold War world. These man-made disasters account for more morbidity and mortality than all natural and technological disasters combined. In order to deliver effective aid during complex humanitarian emergencies, international relief agencies must have a solid understanding of the political and social climates in which they are operating. In addition, they should base their health interventions on objective epidemiological data, especially standardized rates of morbidity and mortality. Most deaths during complex humanitarian emergencies are due to preventable causes, especially increased rates of infectious diseases malnutrition and violent trauma. The most appropriate health interventions are therefore based on the models of public health and primary health care, emphasizing disease prevention and health promotion. The field of humanitarian assistance has become increasingly professionalized in recent years, with its own professional standards, literature, research agenda and training opportunities. It is an unfortunate reflection on the current state of international affairs that the number of complex humanitarian emergencies and the enormous levels of suffering associated with them are unlikely to decline in the foreseeable future.
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Affiliation(s)
- R J Brennan
- International Rescue Committee, New York, USA.
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VanRooyen MJ, Thomas TL, Clem KJ. International emergency medical services: assessment of developing prehospital systems abroad. J Emerg Med 1999; 17:691-6. [PMID: 10431962 DOI: 10.1016/s0736-4679(99)00065-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many developing countries are experiencing a greater need for prehospital systems because of urbanization and changing population demographics, leading to greater death rates from trauma and cardiac illnesses. While emergency medical services (EMS) systems may take a variety of forms, they usually contain some system components similar to those found in the United States. In evaluating EMS abroad, it may be useful to compare the developing system type to one of five models of EMS delivery: hospital-based, municipal, private, volunteer, and complex. Using community-based services and available health providers can enable a developing system to function within a primary health network without overtaxing scarce resources. Developing such an approach can lead to creative and effective solutions for prehospital care in developing countries.
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Affiliation(s)
- M J VanRooyen
- Center for International Emergency Medicine Studies, Department of Emergency Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287-2080, USA
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Aboutanos MB, Baker SP. Wartime civilian injuries: epidemiology and intervention strategies. THE JOURNAL OF TRAUMA 1997; 43:719-26. [PMID: 9356079 DOI: 10.1097/00005373-199710000-00031] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Trauma is the most important public health risk in wartime. Most preventive effort have addressed the political etiology of armed conflicts and the secondary effects of war (food, water, shelter, sanitation, and vector control). Little to no efforts have addressed the direct prevention and control of war trauma. METHODS An extensive review of the literature, with compilation of the most important data. RESULTS Civilians are the major wartime targets in recent wars, and account for most of the killed and wounded. The trend has been toward a greater proportion of injuries from powerful explosive devices such as artillery shells and mines. Lessons learned from Bosnia and Lebanon show that the most effective way to achieve successful surveillance and injury prevention is to enhance the local skills and resources. CONCLUSIONS New approaches are needed to minimize trauma to civilians. Both political advocacy and local efforts (including modifying firearms and ammunition, bullet proof helmets for children, anti-sniper shields) are needed.
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Affiliation(s)
- M B Aboutanos
- Department of International Health, Center for Injury Research and Policy, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA
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Schultz CH, Koenig KL, Noji EK. A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med 1996; 334:438-44. [PMID: 8552147 DOI: 10.1056/nejm199602153340706] [Citation(s) in RCA: 252] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- C H Schultz
- Department of Emergency Medicine, Los Angeles County Harbor-UCLA Medical Center 90509-2910, USA
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