Safe war surgery? (Harald Veen)

‘SAFE’ WAR SURGERY ???

Harald Veen FRCSEd ICRC Chief Surgeon

Now, deliver quality surgery !!

THE ‘MANDATE’

Quality in War Surgery

DBR DC

Problem 1: fracture treatment ICRC dogma:

Functional, plaster, traction, E.F. Never Internal Fixation

Journal of trauma 2009 Mody e.a., Washington: Infectious complications of Damage Control Orthopedics in War Trauma: Intra-medullary nailing after 4-414 days Result: 40% fracture site infection

The French Experience

‘Damage Control Orthopaedics’

Problem 2: Quality

WHO FMT document

Problem 3: Registration

Obligation In home or host country ? Relativety

Problem 4: Requirements Humanitarian Surgeon

Experience Broad Range of Skills Official Registration Available Language, teamwork, religion, skin color,…………………… Quality

GENERAL TRAUMA SURGEON, doing: Abdominal Thoracic NeuroUroOrthopaedic Vascular

Gynae Obst Max-Fac Plast Dental ??????

TRAINING BATLS / PTC / ERTC DSTC / S MSF version STAE Military training modules

REQUEST

PERFORM JUDICIAL AMPUTATION IN THE HOSPITAL

SITUATION

PATIENT PRESENTS AT THE HOSPITAL WITH BLEEDING FOREARM STUMP, IN SEVERE PAIN

ANNOUNCEMENT

JUDICIAL HAND AMPUTATION WILL TAKE PLACE THIS AFTERNOON AT 16.OOH IN THE LOCAL STADIUM PREPARE ER + THEATRE ??

REQUEST

JUDICIAL AMPUTATION WILL TAKE PLACE THIS AFTERNOON 16.00H IN THE LOCAL STADIUM PLEASE SEND AMBULANCE

REQUEST

JUDICIAL AMPUTATION WILL TAKE PLACE THIS AFTERNOON 16.00H IN THE LOCAL STADIUM PLEASE PROVIDE LOCAL ANAESTHESIA

REQUEST

PERFORM JUDICIAL AMPUTATION IN THE HOSPITAL

Problem 6: Humanitarian Aid Scene

Concept of ‘experience’ Up to date? (DC) Business

MAN-MADE DISASTERS

standard mistakes

ICRC.ORG

‘limited resources’

challenge

Application of the DC concept in a setting with limited resources.

Our responsibility

 QUALITY

DBR But not easy to do it well

OTHER ORGANISATIONS