ANAESTHESIA PERSPECTIVE OF COMBAT INJURIES AT SOUTH WAZIRISTAN AGENCY-A FIELD EXPERIENCE OF WAR ON TERRORISM

Anaesthesia Perspective of Combat Injuries

Abstract

Objective: To determine the presentation form of combat injuries, different aspects of anaesthesia management and methods of effective pain control inside the field hospital.

Study Design: A descriptive study.

Place and Duration of Study: South Waziristan Scouts Hospital, South Waziristan Agency, Wana, Khyber Pakhtun Khawa province from March 2007 to August 2009.            

Patients and Methods: A descriptive review of the type of injuries sustained by the troops including local civil population reporting to South Waziristan Scouts (SWS) Hospital from March 2007 to Aug 2009. All patients of combat related injuries reporting to SWS Hospital were included in this study excluding elective surgical cases, gynaecological cases and routine medical patients. Initial anaesthesia management, pain control in anaesthetized patients or analgesia provided without anaesthesia in injured patients and evacuation process of emergencies to tertiary care hospital are discussed. The data was collected from hospital records including operation theatre and was analyzed in the SPSS version 14 for windows in the form of frequency of patients.

Results: A total of 149 male (age 30 ± 15) patients were managed at SWS hospital after sustaining combat related injuries. General anaesthesia was given to 61% patients whereas 26% were operated under spinal anaesthesia. Deaths reported were 12.75% comprising 1.3% brought in dead during combat, 2.68% after cardiopulmonary resuscitation inside the hospital, 2.68% homicides by miscreants, 0.67% suicide,  0.67% of bomb disposal squad during mines search operation and 4.69% due to helicopter crash due to snow fall.  Firearm and splinter injuries were the commonest in active encounter followed by IED linked injuries. Stray bullets injured a soldier in the chest causing pneumothorax and minor injuries to other 2%. Suicide 0.67% of permanent residing troop and homicides of 2.68% soldiers by the miscreants were documented. The time for casualty arrival in the hospital was 15 min to 10 hours depending upon the distance of incidence from the hospital. Ketamine was the drug of choice for induction and pain management followed by thiopentone either alone or in combination with ketamine. nalbuphine IV and diclofenac sodium IM were given to all patients for analgesia. Full stomach and lower limb emergent cases were operated under spinal anaesthesia using hyperbaric 7.5% bupivacaine. Poor supply of medicines, deficient staff and skilled workers, inefficient chain of evacuation and geographical problems were the major difficulties in that area.

Conclusions: Active initial management and team work in a fully equipped setup have the added advantage. Extreme cold, poor team work, hitches in the evacuation, support and supplies were the major problems which if covered can possibly help to manage wounded persons at source.