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Medical aspects of terrorist bombings: A focus on damage control surgery and damage control resuscitation

Journal of Medical Colleges of PLA(China) 2014年第2期29卷 103-108页

作者： Ventsislav M Mutafchiyski Georgi I Popivanov Kirien C Kjossev Endocrine Surgery and Coloproctology Military Medical AcademySofiaBulgaria Clinic of Abdominal Surgery Military Medical Detachment of Emergency Response Military Medical AcademySofiaBulgaria Clinic of Abdominal Surgery Military Medical AcademySofiaBulgaria

Although terrorist bombings have tormented the world for a long time, currently they have reached unprecedented levels and become a continuous threat without borders, race or age. Almost all of them are caused by improvised explosive devices. The unpredictability of the terrorist bombings, leading to simultaneous generation of a large number of casualties and severe "multidimensional" blast trauma require a constant vigilance and preparedness of every hospital worldwide. Approximately 1.0%-2.6% of all trauma patients and 7% of the combat casualties require a massive blood transfusion. Coagulopathy is presented in 65% of them with mortality exceeding 50%. Damage control resuscitation is a novel approach, developed in the military practice for treatment of this subgroup of trauma patients. The comparison with the conventional approach revealed mortality reduction with 40%-74%, lower frequency of abdominal compartment syndrome(8% vs 16%), sepsis(9% vs 20%), multiorgan failure(16% vs 37%) and a significant reduction of resuscitation volumes, both crystalloids and blood products. Damage control surgery(DCS) and damage control resuscitation(DCR) are promising new approaches, contributing for the mortality reduction among the most severely wounded patients. Despite the lack of consensus about the optimal ratio of the blood products and the possible influence of the survival bias, we think that DCR carries survival benefit and recommend it in trauma patients with exsanguinating bleeding.

关键词： terrorist bombings traumatic coagulopathy damage control resuscitation

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bombings specific triage(Bost Tool) tool and its application by healthcare professionals

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World Journal of Emergency Medicine 2015年第4期6卷 289-292页

作者： Jaiswal Sanjay Verma Ankur Kole Tamorish Department of Emergency Medicine Paras Hospitals

BACKGROUND: Bombing is a unique incident which produces unique patterns, multiple and occult injuries. Death often is a result of combined blast, ballistic and thermal effect injuries. Various natures of injury, self referrals and arrival by private transportation may lead to "wrong triage" in the emergency department. In India there has been an increase in incidence of bombing in the last 15 years. There is no documented triage tool from the National Disaster Management Authority of India for bombings. We have tried to develop an ideal bombing specific triage tool which will guide the right patients to the right place at the right time and save more ***: There are three methods of studying the triage tool: 1) real disaster; 2) mock drill; 3) table top exercise. In this study, a table top exercise method was selected. There are two groups, each consisting of an emergency physician, a nurse and a ***: By using the proportion test, we found that correct triaging was significantly different(P=0.005) in proportion between the two groups: group B(80%) with triage tool performed better in triaging the bomb blast victims than group A(50%) without the bombing specific triage tool ***: Development of bombing specific triage tool can reduce under triaging.

关键词： Bombing Blast Injuries terrorist bombings Triage

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