Journal of the Royal Army Medical Corps
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Improvised explosive device (IED) yields in Afghanistan have increased resulting in more proximal injuries. The injury severity score (ISS) is an anatomic aggregate score of the three most severely injured anatomical areas but does not accurately predict severity in IED related pelvi-perineal trauma patients. A scoring system based on abbreviated injury score (AIS) was developed to reflect the severity of these injuries in order to better understand risk factors, develop a tool for future audit and improve performance. ⋯ This scoring system is the initial part of a more complex logistic regression model that will contribute towards a unique trauma scoring system to aid surgical teams in predicting fluid requirements and operative timelines. In austere environments, it may also help to prevent futile resuscitations. Better correlation between measurement of severity and outcome would aid performance improvement monitoring. In the longer term it will also allow benchmarking of current survival rates and comparisons in the future.
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Major pelvic ring fracture (PRF) due to blunt trauma results in lower urinary tract injury (LUTI) in up to 10% of cases. Significant comorbidity may result and this is particularly the case for unrecognised injury. The increase in military injuries due to improvised explosive devices in recent conflicts has revealed a complex injury cohort. ⋯ Military injuries are more complex and require a significantly different approach. This paper outlines the developments in the understanding and management of pelvic fracture-related LUTI, focussing primarily on injury mechanisms and early management. Recent military surgical experience is discussed, highlighting the significant differences to civilian practice.
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Recent military operations have resulted in a small but significant number of military personnel suffering severe perineal injuries. In association with lower limb amputation and pelvic fracture, this complex is described as the 'signature injury' of the current conflict in Afghanistan. There are significant consequences of surviving severe perineal injury but the experience of managing these casualties is limited. This article gives an overview of the processes developed to meet these challenges and introduces a series of articles which examine the subject in finer detail.
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Injuries sustained from Improvised Explosive Devices (IEDs) can have a devastating impact on bodily integrity; physical injuries can be severe and include traumatic amputation of limbs, pelvic fracture, abdominal trauma, extremity fragmentation wounds and genital trauma. Soldiers suffering from genital trauma can experience overwhelming emotions and adjusting to their injuries is a process that occurs over time, that some find easier than others. This paper explores current practice and identifies guidelines for psychological interventions within this arena. ⋯ There is no published evidence base to guide psychological interventions for genital trauma. Professional multidisciplinary intervention will potentially be beneficial in establishing the long-term needs of this patient population, together with qualitative research exploring the experience of soldiers suffering genital trauma.
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The signature injury of the Afghanistan campaign has, amongst other things, included an increased incidence of destructive anorectal injury. There is no significant body of evidence about this type of injury on which to base management strategies. This review examines the historical military data, later civilian reports, many of which have challenged the military dogmas of Vietnam, and the spartan contemporaneous military data which does not particularly address pelviperineal blast injury. There is no evidence to support a move away from the doctrine of the four D's (diversion, distal washout, drainage and direct repair), but sound surgical judgement remains the mainstay of managing these challenging and highly morbid injuries.