• Dan Bieler, Axel Franke, Erwin Kollig, Christoph Güsgen, Martin Mauser, Benedikt Friemert, and Gerhard Achatz.
• Department 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.
• Eur J Trauma Emerg Surg. 2020 Aug 1; 46 (4): 683-694.

AbstractTerrorism-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.

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