Managing Ballistic Injury in the NGO Environment. A Personal View

Abstract

In conflicts where surgical humanitarian intervention is required, it is always in suboptimal conditions. Although the surgical team may be based at a freestanding hospital within or close to the fighting, much of the equipment left either does not work or requires significant ongoing maintenance. Many of the senior local surgeons and their families may leave during protracted hostilities as they see a total collapse of their country’s infrastructure. As the senior surgeons depart, the country is left more than often with enthusiastic but junior surgeons who will take the brunt of dealing with trauma. They may have started specialisation in their training but very quickly need to adapt to cope with the full spectrum of trauma surgery. This is the nub of the problem. Most surgeons at this level are inexperienced and yet they have to deal with very difficult trauma from gunshot wounds and fragmentation injuries. Along with the surgical challenge of how to deal with these injuries, come the constraints of a significant reduction of surgical supplies including blood and surgical materials. There are also the issues of austere post-operative management, lack of intensive care facilities including ventilators and lack of biochemical and haematological laboratory investigations. Discharge from hospital may also be difficult, in that homes may be bombed and patients may have to be discharged to tented accommodation where there is no heating or sanitation. The field hospitals must discharge early or it will not have the beds available to function.