MS01 BOMBS AND BLAST: PRIORITIES AND MANAGEMENT OPTIONS

Abstract

Bomb blast victims have combinations of penetrating, blunt and burn injuries. The more severely injured patients often arrive with hypotension, active haemorrhage, multiple extremity injuries, torso trauma, respiratory compromise, hypothermia, acidosis and traumatic brain injury. The ‘ABCs’ must be performed rapidly. Uncontrolled haemorrhage is a major cause of mortality in these patients. Tourniquets are useful for large extremity wounds with brisk haemorrhage. Whilst resuscitation and triage proceed on the multiple patients, priorities need to be determined for radiology, and theatre based on trauma surgeon triage and resources available. The injuries of the individual patient then need to be prioritised based on the urgency and predicted duration of the surgery and how this will affect overall theatre availability. Patients with head and neck and/or torso trauma should have a CT prior to surgery. Damage control surgery is an essential strategy for all specialties. Prolonged surgery and surgery which is not life‐saving may have to be postponed. The most urgent surgery is to stop severe haemorrhage. Protocols for massive transfusion should be available. There should be a low threshold for tracheostomy in severe head and neck trauma and burns. Simultaneous surgery by multiple teams of surgeons is preferable when there are multiple life threatening injuries eg simultaneous craniotomy, laparotomy and vascular/orthopaedic limb repair. Multiple returns to theatre will be common and must also be accommodated in planning. Australian trauma centres should plan and prepare to receive mass casualties from a bomb blast terrorist event.