Twenty-one-year experience with land mine injuries. 1988

D B Adams, and C W Schwab
Department of Surgery, United States Naval Hospital, Charleston, South Carolina.

Land mines produce devastating injuries which are usually fatal. In Guantanamo Bay, there have been no survivors from close range, functioning antipersonnel mines of the M-16 series. All 15 antipersonnel mine fatalities suffered extremity amputation. Seven of the 15 patients suffered immediately fatal head, neck, or truncal injuries (Type I injury). The three patients who underwent hospital resuscitation had extremity amputation but were spared major head, neck, or truncal injury. It is in this group of injured that potentially salvageable patients can be identified; for them aggressive rescue and resuscitation must be performed. Those with Type II injuries are the highest priority in any triage plan. In a mass casualty or combat casualty scenario, Type II patients, in particular those with high bilateral above-the-knee amputations, may be reassigned to an expectant treatment category so as to allow the main focus on more salvageable patients. The prehospital management plan emphasizes rapid assessment and triage of patients, use of tourniquets to control extremity hemorrhage, supplemental oxygen or endotracheal intubation if possible, neck immobilization, use of the extremity section of the pneumatic antishock garment if applicable, and rapid transport to a hospital. Hospital management of these patients emphasizes aggressive resuscitation, early endotracheal intubation, and rapid volume replacement with simultaneous balanced salt solution and blood. Operative debridement with broad-spectrum antibiotic coverage and tetanus prophylaxis is performed; wounds are managed in an open fashion and frequently examined at subsequent dates in the operating room.

UI MeSH Term Description Entries
D008887 Military Medicine The practice of medicine as applied to special circumstances associated with military operations. Medicine, Military
D008889 Military Personnel Persons including soldiers involved with the armed forces. Air Force Personnel,Armed Forces Personnel,Army Personnel,Coast Guard,Marines,Navy Personnel,Sailors,Soldiers,Submariners,Military,Force Personnel, Air,Personnel, Air Force,Personnel, Armed Forces,Personnel, Army,Personnel, Military,Personnel, Navy,Sailor,Soldier,Submariner
D001753 Blast Injuries Injuries resulting when a person is struck by particles impelled with violent force from an explosion. Blast causes pulmonary concussion and hemorrhage, laceration of other thoracic and abdominal viscera, ruptured ear drums, and minor effects in the central nervous system. (From Dorland, 27th ed) Injuries, Blast,Blast Injury,Injury, Blast
D003462 Cuba An island in the Greater Antilles in the West Indies, south of Florida. With the adjacent islands it forms the Republic of Cuba. Its capital is Havana. It was discovered by Columbus on his first voyage in 1492 and conquered by Spain in 1511. It has a varied history under Spain, Great Britain, and the United States but has been independent since 1902. The name Cuba is said to be an Indian name of unknown origin but the language that gave the name is extinct, so the etymology is a conjecture. (From Webster's New Geographical Dictionary, 1988, p302 & Room, Brewer's Dictionary of Names, 1992, p132)
D005107 Explosions Sudden, violent, and often destructive expansion of gases which propagates energy outward, such as a shock wave, ejecting fragments and debris at high velocities. Explosion
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000673 Amputation, Traumatic Loss of a limb or other bodily appendage by accidental injury. Amputations, Traumatic,Traumatic Amputation,Traumatic Amputations
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014218 Triage The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. Triages
D014481 United States A country in NORTH AMERICA between CANADA and MEXICO.

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