As a civilian orthopaedic surgeon you may never need to manage more than one level-one trauma situation at a time or never have to face a natural or man-made disaster. If, however, these situations do occur, will you know how to most efficiently and effectively save lives with the limited resources at hand?
Consider recent events like 9/11, the earthquake in Haiti, and the disastrous flooding in Afghanistan. Events such as these called to service our Nation’s military forces and the subsequent care of the wounded have led to advances in combat casualty care. The mission of the Society of Military Orthopaedic Surgeons (SOMOS) is to provide a forum for the interchange of medical knowledge as it relates to the practice of orthopaedics in the military. Attending to our wounded warriors is our most sacred task and the lessons learned in caring for the Nation’s finest may benefit all those who care for the victims of disaster and war.
The Disaster Preparedness and Trauma Care Toolbox brings together the combined experience and knowledge of the SOMOS membership in the care of the combat wounded as it applies to humanitarian assistance and disaster relief. When faced with a large number of injured civilians in the austere environment of natural disaster and conflict, disaster preparedness training will assist you with providing orthopaedic care when faced with limited resources.
Explore the Disaster Preparedness Toolbox.
Prepare with STRYKER.
Materials and editorial support for The Disaster Preparedness Toolbox is provided by SOMOS Education Representatives Lt Col Ky Kobayashi, MD and Col. Benjamin Kam, MD.
COL Richard Pope MAJ Michelle Fontaine CPT Charles Grooters I. Soft Tissue Coverage in Austere Environment A. Normally best performed in controlled environment with availability of microscope or loupe magnification B. In rare circumstances, surgeons may need to perform soft tissue coverage procedures in austere environment when evacuation to higher echelon of care not feasible … Read more
CPT David Crawford MAJ Joanna Branstetter Patient Preparation Always prep to allow access for proximal vascular control upper extremity: subclavian artery lower extremity: common femoral artery Preparation should include access to uninvolved limb in case vein graft is needed to be harvested Systemic heparinization (50-75 units/kg IV) should be initiated in stable patients with a … Read more
CPT Daniel J. Stinner, M.D. I. Introduction (see figure 3) A. Typically performed at bedside under sterile condition with IV sedation using electrocautery B. Can also be performed in operating room if immediate access available C. Electrocautery has added benefit of haemostatic control, but if unavailable, scalpel can be used D. General … Read more
CPT Jessica D. Cross CPT Daniel R. Possley I. Introduction A. External fixation may be performed in austere environment without use of fluoroscopy B. Ideally, pins should be placed to minimize impact on future internal fixation II. Pin Placement A. Should be performed as follows (see femoral external fixation placement video) External Fixation – Joe … Read more
CPT Brendan Masini, MD A. Define compartment syndrome and describe the diagnostic limitations presented by an austere environment I. Acute Compartment Syndrome A. Occurs when pressure within myofascial compartment exceeds threshold perfusion gradient across capillary beds 1. if unchecked, leads to tissue hypoxia and cell death 2. ischemia and necrosis … Read more
CPT Daniel J. Stinner, M.D. CPT Chad A. Krueger, M.D. A. Describe the initial evaluation and management of a burn patient I. Background A. Types of burn injuries 1. thermal 2. electrical 3. chemical 4. cold 5. radiation B. Recent civilian disasters resulting in multiple burn casualties1 … Read more
CPT Daniel Stinner, M.D. B. Define early management of extremity burns I. Early Wound Management A. Introduction 1. not necessary to perform immediately, but should be done within first 24 hours 2. ensure patient receives adequate pain medicine, as wound care can be very painful B. Goal 1. … Read more
CPT David Crawford MAJ Joanna Branstetter A. Define the initial evaluation and demonstrate appropriate evaluation techniques of a patient with an extremity vascular injury I. Initial Evaluation A. Initial evaluation should always follow acute trauma lifesaving support (ATLS) B. Application of a tourniquet above the level of injury is appropriate … Read more
CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D. A. Describe the initial management, resuscitation, and stabilization of pelvic fractures Pelvic Fractures I. Epidemiology A. High energy mechanism of injury requires instantaneous deceleration of 30 mph to injure pelvic ring B. Large association with other injuries including head, chest, abdomen, and extremity trauma … Read more
V. Axial Skeleton Injuries in an Austere Environment (continued) CPT Jeanne Patzkowski, M.D. CPT Chad Krueger, M.D. A. Describe the initial management, resuscitation, and stabilization of pelvic fractures III. Resuscitation A. Mortality rates as high as 40% with hemodynamic instability 1. major cause of death in first 24 hours: exsanguinating … Read more