T Ramalingam. OP TELIC - Extremity Injuries Remain A High Surgical Workload In A Conflict Zone: Experiences Of A British Field Hospital In Iraq, 2003

Background During this conflict 34 Field Hospital, the sole Coalition field hospital located in Iraq, received and treated casualties with a wide range of injuries. Located very close to the front line during the period of combat hostilities, it was potentially going to deal with relatively fewer battleinjured extremities. Method A retrospective review of battle casualties admitted to the hospital was carried out based on casualty records and operating theatre logbooks. Data was collected for the period between the 26th March and the 8th May, focusing on casualties who had surgery for battle-injured extremities during the conflict. Results Sixty eight (55%) of the 124 casualties who underwent surgery did so for battle injuries to extremities. 139 (58%) of all operating theatre episodes and 189 (53%) of all surgical procedures undertaken were for battle-injured extremities. Fourteen major limb amputations were carried out from a total of 87 battleinjured limbs that had surgery, giving an amputation rate of sixteen percent (14/87). Conclusion The experience at 34 Field Hospital confirms that extremity injuries do confer a high surgical workload in war. Surgical resources should, therefore, be aimed at this and surgical teams deployed to such environments should be well versed in the surgical management of casualties with limb trauma. Background Medical facilities in a conflict zone receive and treat casualties with a wide range of injuries. The workload and type of surgical intervention of field surgical teams is determined by many factors. These include the type and intensity of the conflict itself and the efficiency of casualty retrieval from the point of wounding. The role of the medical facility, whether it is for humanitarian purposes or purely to support a strategic military effort, will no doubt also influence the surgical workload. Treatment of casualties with extremity injuries is common in war.This is supported by the experiences of International Committee of Red Cross (ICRC) hospitals in Asia and in Africa (1). Among the Afghan war wounded treated in the ICRC hospital, Quetta, two thirds of patients were treated for limb injuries and those with long bone fractures needed the greatest number of repeated operations and longest hospitalisation time (2). It has been argued that the distant location of ICRC hospitals from the front line means that ‘severely’ injured casualties e.g. with abdominal, chest and head wounds, do not survive to make it to these facilities. Does this mean that field hospitals located near front lines receive or treat fewer extremity-injured casualties? A recent paper describing the combined surgical experience in ten field hospitals during the Iran-Iraq war, lists laparotomy as the commonest surgical procedure performed, comprising 30% of all surgical interventions (3). The authors quote the subsequent commonest surgical procedures as those to the chest (21.5%) with “orthopaedic” procedures, comprising of only 16.8% of all surgical interventions. Based on the surgical experience of 34 Field Hospital, the sole Coalition field hospital located very close to the front line, at the time of the conflict, this paper aims to highlight the high surgical workload conferred by battle-injured extremities in a conflict setting. Method At the onset of the war in Iraq, 34 Field Hospital, a 200-bedded British Field Hospital, was mobilised to southern Iraq. It was established in its forward position on the 26th March in order to provide medical support for Coalition troops and to deal with Iraqi casualties. The hospital comprised of a reception/triage area, an eight bay resuscitation area, three operating theatres (2 operating tables in each), an intensive care unit and 8 wards. There were limited pathology and radiology services available. Six surgeons (3 general and 3 orthopaedic) deployed with the hospital and worked as paired specialists. Data was collected retrospectively from the surgical casualty database, individual casualty records, and from the operative logbooks. From these sources the number of casualties who underwent surgery for both battle and non-battle injuries were determined. The numbers of operative procedures performed and of operating Maj T Ramalingam Department of Colorectal Surgery, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU Email:[email protected] OP TELIC Extremity Injuries Remain A High Surgical Workload In A Conflict Zone: Experiences Of A British Field Hospital In