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Terrorist attacks: common injuries and initial surgical management
Dan Bieler1, Axel Franke2, Erwin Kollig3
1Department of Trauma Surgery and Orthopaedics, Reconstructive and Hand Surgery, Plastic Surgery, Burn Medicine, German Armed Forces Central Hospital, Koblenz, Rübenacher Straße 170, 56072, Koblenz, Germany. dr.dan.bieler@t-online.de.
Abstract:
Terrorism-related incidents and shootings that involve the use of war weapons and explosives are associated with gunshot and blast injuries. Despite the perceived threat of terrorism, these incidents and injuries are rare in Germany. For this reason, healthcare providers are unlikely to have a full understanding of the special aspects of managing these types of injuries. Until a clear and complete picture of the situation is available after a terrorist or shooter incident, tactical and strategic approaches to the clinical management of the injured must be tailored to circumstances that have the potential to overwhelm resources temporarily. Hospitals providing initial care must be aware that the first patients who are taken to medical facilities will present with uncontrollable bleeding from injuries to the trunk and body cavities. To improve the outcome of these patients in extremis, the aim of the index surgery is to stop the bleeding and control the contamination. Unlike damage control surgery, which is tailored to the patient's condition, tactical abbreviated surgical care (TASC) is first and foremost adapted to the overall situation. Once the patients are stabilised and all information on the situation is available, the surgical management and reconstruction of gunshot and blast injuries can follow the principles of damage control (DC) and definitive early total care (ETC). The purpose of this article is to provide an overview of the pathophysiology of gunshot and blast injuries, wound ballistics, and the approach and procedures of successful surgical management.
Insights
Managing rare but severe gunshot and blast injuries requires adapting surgical care to the overall situation, not just the patient's condition. Tactical abbreviated surgical care (TASC) prioritizes immediate bleeding control and contamination management for critically injured patients.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Ballistics
Background:
- Terrorism and mass shootings, though rare in Germany, pose unique challenges for healthcare providers.
- These incidents often result in severe gunshot and blast injuries, overwhelming medical resources.
- Limited experience with these injuries necessitates specialized management strategies.
Purpose of the Study:
- To provide an overview of the pathophysiology and wound ballistics of gunshot and blast injuries.
- To outline a strategic approach to the clinical management of mass casualty incidents.
- To introduce Tactical Abbreviated Surgical Care (TASC) as a situational adaptation for initial surgical management.
Main Methods:
- Review of pathophysiology and wound ballistics.
- Description of a phased surgical approach: TASC, Damage Control (DC), and Early Total Care (ETC).
- Emphasis on adapting surgical care to the evolving incident situation and patient condition.
Main Results:
- Initial surgical management focuses on immediate hemorrhage control and contamination management in critically injured patients.
- Tactical Abbreviated Surgical Care (TASC) is proposed as a situation-driven approach for initial interventions.
- Subsequent surgical phases (DC and ETC) are guided by patient stabilization and comprehensive situational information.
Conclusions:
- Effective management of gunshot and blast injuries requires a paradigm shift from traditional damage control to situation-adapted care.
- TASC enables initial stabilization in mass casualty events, improving outcomes for severely injured patients.
- A phased approach integrating TASC, DC, and ETC ensures comprehensive surgical management from initial response to definitive reconstruction.
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