Oh John S, Seery Jason M, Grabo Daniel J, Ervin Mark D, Wertin Tom M, Hawks Ryan P, Benov Avi, Stockinger Zsolt T
Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX.
Mil Med. 2018 Sep 1;183(suppl_2):24-28. doi: 10.1093/milmed/usy064.
The purpose of this Clinical Practice Guide is to provide details on the procedures to safely remove unexploded ordnance from combat patients, both loose and impaled, to minimize the risks to providers and the medical treatment facility while ensuring the best outcome for the patient. Military ordnance, to include bullets, grenades, flares, and explosive ordnance, retained by a patient can be a risk to all individuals and equipment along the continuum of care. This is especially true from the point of injury to the first treatment facility. Management of patients with unexploded ordnance either on or in their body is a rare event during combat surgery. Loose munitions are usually noted and easily removed prior to the patient receiving medical treatment. However, impaled munitions provide a significant challenge. These are usually caused by large caliber, high-velocity projectiles. Patients who survive to arrive at a treatment facility must be triaged safely and simultaneously treated appropriately to ensure both the survival of the patient and the treatment team. Between WWII and the Somalia conflict, there have been 36 reported cases of unexploded ordnance from U.S. soldiers. Since 2005, there have been six known cases during the U.S. wars in Afghanistan and Iraq and one additional case in Pakistan. Optimal outcomes require a basic knowledge of explosives and triggering mechanisms, as well as adherence to basic principles of trauma resuscitation and surgery.
本临床实践指南的目的是详细说明从战斗伤员身上安全移除未爆炸弹药的程序，包括松散的和刺入体内的弹药，以尽量减少对医护人员和医疗设施的风险，同时确保患者获得最佳治疗效果。患者体内留存的军事弹药，包括子弹、手榴弹、照明弹和爆炸弹药，可能会对整个护理过程中的所有人员和设备构成风险。从受伤点到首个治疗机构的过程中尤其如此。在战斗外科手术期间，处理体内或身上带有未爆炸弹药的患者是罕见情况。松散的弹药通常在患者接受治疗前就会被发现并容易移除。然而，刺入体内的弹药带来重大挑战。这些通常是由大口径、高速射弹造成的。存活至抵达治疗机构的患者必须得到安全分诊，并同时接受适当治疗，以确保患者和治疗团队都能存活。在第二次世界大战至索马里冲突期间，有36例关于美军士兵未爆炸弹药的报告病例。自2005年以来，在美国在阿富汗和伊拉克的战争中有6例已知病例，在巴基斯坦还有1例。要取得最佳治疗效果，需要掌握炸药和触发机制的基本知识，并遵循创伤复苏和手术的基本原则。
