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战争相关烧伤的管理:从近期持续冲突中汲取的经验教训,在特殊地点提供卓越护理。

Management of war-related burn injuries: lessons learned from recent ongoing conflicts providing exceptional care in unusual places.

作者信息

Atiyeh Bishara S, Hayek Shady N

机构信息

Euro-Mediterranean Council for Burns and Fire Disasters-MBC, Palermo, Italy.

出版信息

J Craniofac Surg. 2010 Sep;21(5):1529-37. doi: 10.1097/SCS.0b013e3181f3ed9c.

Abstract

Thermal injury is a sad but common and obligatory component of armed conflicts. Although the frequency of noncombat burns has decreased, overall incidence of burns in current military operations has nearly doubled during the past few years. Burn injuries in the military environment do not need to be hostile in nature. Burns resulting from carelessness outnumber those resulting from hostile action. Unfortunately, civilians are becoming the major targets in modern-day conflicts; they account for more than 80% of those killed and wounded in present-day conflicts. The provision of military burn care mirrors the civilian standards; however, several aspects of treatment of war-related burn injuries are peculiar to the war situation itself and to the specific conditions of each armed conflict. Important aspects of management of burned military personnel include triage to ensure that available medical care resources are matched to the severity of burn injury and the number of burn casualties, initial management and resuscitation in the combat zone, and subsequent evacuation to higher echelons of medical care, each with increasing medical capabilities. Care of military victims is usually well structured and follows strict guidelines for first aid and evacuation to field hospitals by military personnel usually having had some form of training in first aid and resuscitation and for which necessary equipment and material for such interventions are more or less available. Options available for civilian injury intervention in wartime, however, are limited. Of all pre-hospital transport of civilian victims, 70% are done by lay public and 93% receive in the field, or during transport, some form of basic first aid administered by relatives, friends, or other first responders not trained for such interventions. Civilian casualties frequently represents 60% to 80% of all injured admitted to the level III facilities of overseas forces stationed throughout the host country. Unlike military personnel who are rapidly evacuated to higher echelons IV and V for definitive and long-term care, civilians must receive definitive burn treatment at these level III military facilities. The present review was intended to highlight peculiar aspects of war-related burn injuries of both military personnel and civilians and their management based on the most recently published material that, for the most part, is related to the recent conflicts in Iraq and Afghanistan.

摘要

热损伤是武装冲突中令人痛心却又常见且必然出现的一部分。尽管非战斗烧伤的发生率有所下降,但在过去几年里,当前军事行动中烧伤的总体发生率几乎翻了一番。军事环境中的烧伤不一定是由敌对行为造成的。因粗心大意导致的烧伤比敌对行动造成的烧伤更多。不幸的是,平民正成为现代冲突中的主要目标;在当今冲突中,平民伤亡人数占总伤亡人数的80%以上。军事烧伤护理标准与民用标准类似;然而,与战争相关的烧伤治疗在几个方面因战争局势本身以及每场武装冲突的具体情况而具有特殊性。烧伤军事人员管理的重要方面包括进行伤员分类,以确保可用的医疗资源与烧伤的严重程度和烧伤伤员数量相匹配,在作战区域进行初步管理和复苏,以及随后将伤员后送至医疗能力不断增强的更高层级医疗机构。对军事受害者的护理通常组织有序,遵循严格的急救和后送指南,军事人员通常接受过某种形式的急救和复苏培训,并且或多或少具备此类干预所需的设备和物资。然而,战时平民受伤干预的选择有限。在所有平民受害者的院前转运中,70%是由普通民众完成的,93%在现场或转运过程中接受了亲属、朋友或其他未经此类干预培训的急救人员提供的某种形式的基本急救。平民伤亡人数通常占驻扎在东道国各地的海外部队三级医疗机构收治的所有伤员的60%至80%。与迅速后送至更高层级四级和五级医疗机构接受确定性和长期护理的军事人员不同,平民必须在这些三级军事设施接受确定性烧伤治疗。本综述旨在根据最近发表的大部分与伊拉克和阿富汗近期冲突相关的材料,突出军事人员和平民与战争相关的烧伤损伤及其管理的特殊方面。

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