Medics 'need bomb wound training'

The British Lancenet reports that the number of dead can be drastically reduced if they are empowered with the necessary knowledge of the blasts and a special training.BBC Report

The bombing of a London bus took place outside the doctors' union

Doctors need more training to deal with the victims of bomb blasts given the current threat of terrorism, a Lancet paper says.

The injuries wrought by explosive devices are unique and the chances of survival depend greatly on recognition, US doctors write.
From air entering the arteries to serious damage to the bowel wall, the wounds can be diverse.
UK experts agreed there was an urgent need to understand these injuries.
Figures on terrorism are notoriously controversial in part due to varied definitions of what constitutes a terrorist act.
But doctors from the Denver Health Medical Center cite "conservative estimates" suggesting such events have risen four-fold from 1999 to 2006 worldwide.
"Special-interest, militant, and extremist groups have realised the profound effect explosions can have in civilian settings. Nightclubs, trains, subways, planes, and other popular sites have been targeted in recent years by these groups and caused substantial civilian casualties," wrote lead author Stephen Wolf, an emergency medicine specialist.
"Health-care systems must be able to provide care for the people and communities that are affected. Thus, every physician involved with emergency care needs to understand the unique injury patterns and management of people injured by an explosion."
Pressure wave
It is the pressure caused by blasts as air is displaced - generating winds of of several hundred km/h - that causes injury. If a person is standing next to a wall or in a contained space the blast pressure is intensified as the wave "reflects back".
This pressure can causes immense damage within the body, particularly those with a direct airway outside the body, for instance the gastrointestinal system and the lungs.
Between 17 and 47% of people who die after an explosion have evidence of these pressure injuries in their lungs.
The doctors highlight the problem of potentially fatal arterial air embolisms, when air enter the arteries - seriously reducing blood supply.

Most important of all, I believe, is the understanding that blast injury usually occurs in the context of a mass casualty incident, the logistics of which are vastly different than the care of an individual patient Pinhas Halperin Tel Aviv Sourasky Medical Center

In the gastrointestinal system, blast injuries can cause damage to the bowel wall and disrupt blood flow to the intestines, requiring particular care.
In the UK, which has a longer history of bomb attacks than the US, there has long been recognition of the need to understand the specific nature of bomb wounds, experts say.
"But there is now an increased risk, and doctors need to be prepared to manage such cases. This paper provides a level of detail which really raises the bar," says Dr John Heyworth, president of the College of Emergency Medicine.
"It has to be a key part of training. Of course you'd hope you would never need it, but doctors often have to be well versed in things that they may never in fact see in the course of their career."
Bombings in London four years ago led to calls for all doctors to receive more training in blast wounds. Non-emergency doctors were among the first on the scene when a bus exploded outside BMA House, home of the doctors' union.
But one specialist from Israel said his country's experience illustrated that good organisation was as crucial as the knowledge and understanding of the injuries inflicted, and potentially more difficult to achieve.
"Most important of all, I believe, is the understanding that blast injury usually occurs in the context of a mass casualty incident, the logistics of which are vastly different than the care of an individual patient, and this is the emphasis we are bringing forward: how to provide the best of care under adverse conditions," said Dr Pinhas Halperin, head of the Department of Emergency Medicine at Tel Aviv Sourasky Medical Center.
"We assume that the medical aspects are easily learned, while the organisational aspects, the functioning of the individual in the context, need constant drilling beyond the normal scope of training of both doctors and paramedics."