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Chapter 18 - Orthopedics in a Field Hospital

from Section 4 - Clinical Considerations

Published online by Cambridge University Press:  09 January 2020

By
Elhanan Bar-On  and
Patrick Herard
Edited by
Elhanan Bar-On ,
Kobi Peleg  and
Yitshak Kreiss
Elhanan Bar-On
Affiliation:
The Israel Center for Disaster Medicine and Humanitarian Response, Sheba Medical Center, Tel Hashomer, Israel
Kobi Peleg
Affiliation:
National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Health Policy and Epidemiology and Tel-Aviv University, Disaster Medicine Department
Yitshak Kreiss
Affiliation:
Sheba Medical Center, Tel Hashomer, Israel
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Summary

Orthopedic treatment in a field hospital setting differs significantly from that in everyday practice in a high-income country. Field hospitals are deployed in a variety of scenarios, most commonly following earthquakes and armed conflicts, which cause a high incidence of musculoskeletal injuries. One should anticipate a large caseload of life and limb threatening injuries, delayed presentation with subsequent infections, limited operating theatre sterility, and a paucity of imaging, instrumentation, and fixation hardware.

These limitations dictate a damage control treatment approach, which includes “life over limb"": prioritizing life saving to limb saving procedures. Contamination and infection are treated by aggressive surgical debridement of contaminants and non-viable tissues. Fracture fixation is performed using the simplest and quickest methods; usually external fixation for open fractures casting for closed fractures, avoiding open reduction and internal fixation due to limited surgical sterility.

Indications for amputation include non-viable limbs due to irreparable vascular damage or severe crush injuries and infections uncontrollable by surgical and medical means.

Surgical decisions should take into account the cultural variability in the disaster milieu and informed consent should be obtained using interpreters, family and community members, and local medical personnel.

Keywords

Disaster medicinefield hospitalaustere environment surgerycrush injuryopen fracturedamage control surgeryexternal fixation
Type
Chapter
Information
Field Hospitals
A Comprehensive Guide to Preparation and Operation
 , pp. 180 - 195
Publisher: Cambridge University Press
Print publication year: 2020

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