Page 118 - JSOM Winter 2018

Surgical Care of Combat Trauma in the trauma-centers within 45 minutes after the incident. 3 other
Nigerian Armed Forces patients either needed extrication or anesthesia (severe
Surgical Care of Combat Trauma in the Nigerian Armed Forces head-injury). These patients were hospitalized between 70 and
100 minutes after the attack. Autopsy proved all 3 deaths inev-
he decade-long Boko Haram Insurgency in the North East- itable. One additional patient died 18 days after the incident.
Tern flank of Nigeria has resulted to gross economic loss,
infrastructural destruction and loss of lives. The war against Conclusions
this national security threat with attendant deployment of the Immediate evacuation of an incident is a major burden for
Armed Forces has brought about near return of peace to the triage, patient-care and transport. Mass-incident equipment is
troubled region. However, with deployment and combat come needed at an early state. In this case the explosives found were
injuries and deaths to Soldiers, Sailors and Airmen. The re- not equipped with lighting. The reports of additional suspects
sponsibility to prevent, treat and rehabilitate these wounded were proved to be false.
warriors lies with the military health system. The entire chain
of survival system starting from point of injury to rehabilita-
tion is in incremental fashion according to the echelon of the Terror Attacks in Brussels on March 22nd, 2016:
combat arm being supported. Despite the unconventional tac- The Belgian Experience
tics and use of improvised explosive devices by the insurgents, J.C. de Schoutheete, E. Mergny, G. Vaes J, Borgers
troops’ survival from resultant horrific wound has remained n 2016, 1,441 attacks were counted for a total of 14,356
impressive. Wound debridement and delayed primary closures Ifatalities worldwide. In Europe, more specifically, the ter-
of wounds were the commonest procedures in the field hospi- ror attacks in Nice were the heaviest with 86 dead followed
tal in this conflict. Better survival is attributed to incremental by the ones in Brussels on March 22nd with 32 deceased. In
improvement in the medical process, personnel and infra- terms of number of injured people on that day, the attacks in
structure over the years. Aeromedical evacuation and prompt Brussels were proportionally not so deadly. In total, there were
surgical intervention has played a vital role in the highlighted 324 hospital contacts related to the attacks. Why a so low
improved survivability. 419 (98% of total) casualties were proportion of fatalities in a country where no trauma system
evacuated within the period of January 2017 and April 2018 exists yet and knowing that the evacuation of casualties was
by air component of OPERATION LAFIYA DOLE. made difficult by a dysfunctional mobile network as well as
The concerted effort of the Federal Republic of Nigeria in win- by a change of evacuation plan after the second attack in the
ning the war and mission to boost the morale and care of the underground?
traumatized troops led to frequent very important personality At a coordination level, the crisis center first tried quite suc-
visits to the wounded and enhanced rehabilitation. Rehabilita- cessfully to turn the mass casualty event into a minor mass
tion is geared towards restoration of the wounded to the high- casualty event, keeping care containable. Patients were first
est possible functional level, optimal reintegration and return brought to the nearest hospital, but were then relocated to
to productive capacity. Visible in the counter-insurgency effort main hospitals farther away. Furthermore, the military hospi-
is also enhanced collaboration with allied Armed Forces and tal in Brussels was used as a buffer capacity. The first Forward
civilian health organizations. This mix is improving surgical Medical Post (FMP) was moved to the military hospital, which
care of combat trauma and enhancing training and research created a new FMP in a safe area.
capacity of the surgical care givers.
At an intra-hospital level, not every patient requested a to-
tal body computed tomography scanner, which preserved re-
Management of the Amok-Assault of sources. Key-resources like emergency room, intensive care
Muenster Germany and operating room were built up gradually during the day.
Surgical Care of Combat Trauma in the Nigerian Armed Forces Safety measures were also implemented gradually due to the
Introduction level three terror threat in which the country was at that time.
On April 7th, 2018 a van was deliberately driven into a group In sum, as terror attacks by coordinated groups become more
of restaurant guests in the historic city-center of Muenster, Ger- sophisticated and as more random attacks as well are made
many. The driver committed suicide by gunshot straight after simultaneously on soft targets in western countries, using new
the assault: 25 people were injured, 3 declared dead on scene.
terror methods of improvised explosive devices radio com-
manded or vehicle/drone borne or by making dirty bombs, we
Development need to be prepared as good as possible. At a coordination
Triage was initiated and resulted in 6 patients in acute level, the attacks in Brussels have shown that first, the battle-
life-threatening condition (“red”), 6 severely injured (“yel- field experience with tactical casualty care and damage con-
low”) and 13 with minor injuries (“green”). During the start trol resuscitation is important; second, a secondary FMP and
of the rescue-attempt police recognized explosives in the back a buffer capacity are paramount; and third, communication
of the van. Additionally, eye-witnesses reported that two men is always the Achilles tendon in a mass casualty event. Beside
had fled the incident-scene carrying weapons. The scene was this, March 22nd has also revealed that the intra-hospital dy-
therefore declared unsafe by police and had to be evacuated namic needs to be improved by developing access plans, by
during the rescue. Patients had to be carried on stretchers or learning the pathology to be expected and related training, by
led to a save area secured by armed police.
making cards to describe staff functions, by elaborating a di-
saster plan and relevant training with, e.g., some e-learnings
Results for all staff of main national hospitals.
All patients received advanced trauma life-support care. Of
the 6 patients in life-threatening condition 3 reached the

116 | JSOM Volume 18, Edition 4 / Winter 2018