Management of Gunshot Wounds and Other Urban War Injuries

Abstract

SUMMARY Injuries in urban warfare can range from the most minor to devastating and life threatening. Multidisciplinary care is needed for the successful management of the survivors. The experience in Northern Ireland has involved baton rounds, high- and low-velocity gunshot wounds, shotgun injuries, and bomb blasts. A large number of injured people may arrive at the hospital at the same time, and a disaster plan allows for their effective handling. At the hospital, the primary aim is the preservation of life, principally through control of the airway, arrest of hemorrhage, and an awareness of possible complications. The amount of energy given up by a missile is proportional to the kinetic energy. A number of factors affect the amount of energy, whether the missile stays within the body or passes through (penetrating or perforating), the type of bullet, and its stability in flight. Simple consideration of muzzle velocity may lead to erroneous assumptions. Specific types of wounds are seen in baton round injuries, low-velocity and high-velocity missile wounds, shotgun wounds, and as a result of bomb blasts. In each type, it is important to follow the plastic surgery principle of putting