Management of combat casualties received during war on terrorism in Federally Administered Tribal Area [FATA] and Swat Valley of Pakistan

ABSTRACT

The aim of this study was to highlight the excessive workload on the under staffed surgical teams, handling the combat mass casualties of 'war on terrorism'. Triage, nature of injuries sustained, operative management, post operative care and the outcome in terms of morbidity and mortality are discussed. This study was carried out at Combined Military Hospital [CMH] Peshawar Pakistan, from July 2008 to June 2009. A total of 1309 evacuated combat casualties were received at this hospital from the combat zone during this period and 1847 surgical procedures [1128 minor and 719 major] were performed. The major surgical procedures were performed for 80 abdominal, 204 orthopedic, 12 chest, 31 neurological, 17 vascular and 375 multiple injuries [including burns, amputations, foreign bodies, deep lacerated wounds, ENT, eye and orodental injuries]. Two surgical teams, each comprising of 2 anesthesiologists, 6 surgeons and 18 operating room assistants [ORA], worked alternatively, round the clock in 6 operating rooms. It was a race against the time as almost all the patients requiring major surgery, were in shock state. Resuscitation and surgical procedures had to start simultaneously. Only two trained nurses were looking after 11 critically ill patients in 1CU and just one nurse was available for 20-30 patients in the general ward at any given time. Out of a total of 1309 patients, 1298 survived, 29 required ventilatory support. Out of 10 patients of penetrating head injury 6 developed brain death and were removed from the ventilator, 4 were successfully weaned off. Five patients died due to septicemia, DIG [disseminated intravascular coagulation] and multiple organ dysfunction syndrome [MODS]. Combat casualties comprise of a spectrum of trauma; head injury, hemorrhage and septicemia are the main killers. Apart from optimal use of resources available, it is the shear dedication and commitment to the service that drives the men to work continuously for long hours to manage mass combat casualties efficiently and yield good result: