Hostage Rescue Surgery

Abstract

In the early morning hours of 1 April, 2003, a combined force of US Marines, Army Rangers, Navy SEALS, and Special Operations aviation assets conducted a daring rescue of Private Jessica Lynch from Saddam Hospital in Nasiriyah, Iraq. The first successful rescue of a female POW demanded a special set of medical preparations. Suffering from multiple injuries, possible psychological and/or sexual abuse, disorientation including geographic and social isolation presented challenges to the health care providers charged with her repatriation. Unfortunately, the increase in kidnapping whether by terrorist networks, drug cartels, or piracy clans shows no sign of diminishing. Aid workers, relief organizations, leisure sailors, or travelers have, all too often, represented the soft targets for these outfits. Most events occur in remote locations with sparse or nonexistent medical support structure offering little in the way of complex multidisciplinary surgical expertise.

For the surgeon faced with the daunting task of assessing, treating, and recovering these victims, whether as part of an overseas humanitarian mission or the nearest community hospital, these traumas require an alternate approach. Sound surgical principles still apply but often require modifications to achieve desired results. Preoperative assessment considering psychological and emotional stressors which may magnify apparent severity of relatively stable appearing injuries needs to be utilized in these situations. Operative determination of expeditious interventions following damage control principles geared to maintain the patient continuum of repatriation. Finally, extraction contingencies designed to provide injury specific support in transit to tertiary level multidisciplinary care and eventual patient homecoming.