Providing Emergency Care to the Civilian Population (Organization, Anesthesia, Intensive Care) in Mass Casualty Incident of Wartime
The paper presents the experience of emergency care to civilians at mine-explosion and gunshot injuries, including patient flow during mass-casualty incidents. The most important are the organizational measures to mobilize available resources (medical staff, equipment, drugs) and their effective use. In combined injuries of the skeleton and the abdominal or thoracic cavity, the spinal cord or brain, various experts (traumatologists, surgeons, neurosurgeons) must be immediately involved in care providing. In these circumstances, the role of coordinator can, and in many cases should play the most experienced anesthetist.
After conducting triage all efforts should be aimed to minimize blood loss and as soon as possible arrival of most severely injured patients to operating room. Patients with concomitant and combined injuries in many cases should be simultaneously operated by two surgical teams (e.g. intra-abdominal bleeding stop and decompression craniotomy for hematoma removing). In massive bleedings, besides hemostasis, efforts should be aimed to carry out an immediate blood transfusion (packed red blood cells and blood plasma). In case of blood pressure reduction to a level that threatens the perfusion of vital organs, we have positive experience of low-volume fluid resuscitation with the adding of adrenaline to crystalloid solution. The most important factor in the treatment of traumatic shock is the early usage of powerful analgesics or regional anaesthesia.
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