WMDs Are Not Just Overseas Anymore - Orthopaedic Surgeons Must Prepare Management And Patient Care Plans Before Disaster Strikes

August 8, 2007 – 2:32 am | posted in Bones / Orthopaedics

Escalation of terrorism and the potential for catastrophic events caused by weapons of mass destruction (WMD) during the last three decades has created the need for unique disaster management. A new study in the August 2007 issue of the Journal of the American Academy of Orthopaedic Surgeons, reviews how orthopaedic surgeons and other medical personnel can develop disaster management plans for events where WMDs are used and establish an infrastructure to mitigate injury and loss of life.

“Victims of terror attacks have more severe injuries, a higher need for intensive care units, a prolonged hospital stay and a higher mortality rate than other trauma patients,” said co-author Christopher T. Born, MD, chief of the orthopaedic trauma at Rhode Island Hospital, Brown University in Providence. Dr Born noted that WMDs include:

– Explosives which cause 82 percent of all injuries from terrorist attacks

– Biological & Chemical nerve, blood, pulmonary agents (chlorine and phosgene), blistering (vesicants such as mustard gas and sarin) and other chemicals used for riot control

– Nuclear Agents Or Radiation from detonation of a nuclear device, sabotage or meltdown of a nuclear reactor, conventional explosion (”dirty bomb” which combines conventional explosives with radioactive isotopes) or non-explosive dispersal of radioactive material in a public place

“Orthopaedic surgeons must understand blast mechanics and patterns of injury, clinical symptoms, and recommended management strategies,” added Dr. Born. “This knowledge about potential biological, chemical and nuclear agents may improve diagnostic and treatment strategies.” Blast injuries include:

– A Shock Front And Blast Wave that can move through the body. Most injuries occur to the ears, lungs and gastrointestinal tract.

– Shrapnel caused by the explosion of the bomb’s casing which may include nails, screws and nuts and bolts.

– Airborne Fragments, such as glass, from around the area of explosion.

Dr. Born says that orthopaedic surgeons may have to make difficult decisions regarding which wounds to explore and clean out, however X-rays can be used to evaluate for foreign bodies. They also may have to use special management of bone fragments wounds from hepatitis C or HIV infected suicide terrorists. Others injuries they may address include:

– Fractures, Head Trauma and other blunt injuries when a victim’s body is thrown as a projectile by the blast

– Penetrating Injuries caused by projectiles that may be contaminated, but can be treated with antibiotics and tetanus shots

– Patients Being Crushed or who have traumatic amputation, compartment syndromes or other blunt and penetrating injuries due to structural collapse

– Burns which are secondary to the blast from lower energy explosives, like gunpowder which causes thermal injury because of incomplete combustion

– Flash Burns to exposed skin from the thermal component of the blast

– Additional Burns and smoke inhalation from secondary fires

– Traumatic Amputations from direct laceration by projectiles formed secondary to the blast or from fractures caused by axial stress to the long bone after the flailing of the extremity from the blast wind

“Orthopaedic surgeons and medical personnel must understand toxicity, mechanisms, clinical signs, symptoms, and management of exposure and treatment,” said Dr. Born. “Planning for probable, high impact disasters is well within our capability and it is essential that an orthopaedic surgeons’ training incorporates disaster management and mass casualty response.”

American Academy of Orthopaedic

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