In this video, we discuss the switch to damage control surgery once a mass casualty is declared at a health facility. The content is designed for healthcare professionals.
TRANSCRIPT
Let's find out why you have to switch to damage control surgical tactics and abbreviated surgery for mass casualties in your medical facility.
Mass casualty incidents usually result in many patients requiring immediate surgical intervention to save their lives or limbs.
Fast identification of these patients as 'red' patients in the emergency department is crucial, but further steps will determine how many of these patients can be saved.
As surgical resources (staff, space and equipment) are often limited during mass casualty events, every surgeon, anesthetist and nurse involved in mass casualty operations should understand why the traditional single-stage surgical approach must be replaced by a multi-stage damage control
approach and abbreviated surgery.
The aim of reducing operating time in the operating room during a mass casualty is:
1. Increased likelihood of survival for patients who need aid by damage control tactics.
2. It allows for operating on more patients in a shorter time.
Damage control surgical tactics are generally a multi-stage procedure to save life or limb.
Their priority is to stop bleeding; prevent injury contamination; and restore physiological functions, thus breaking the triad of death: coagulopathy, hypothermia and acidosis.
In massive casualty cases, patients with hypovolemic shock are good candidates for damage control surgical tactics.
The surgical tactics of damage control are not limited to abdominal surgery.
All surgical specialties have their own rules for damage control tactics, and these rules need to be applied to individual patients when, in general, we treat and try to restore the body's physiology.
In the damage control surgical tactics, we use external fixators instead of plates and screws; vascular shunts instead of vascular anastomoses; bowel ligation instead of anastomosis; abdominal tamponade instead of selective hemostasis of the liver or spleen.
Temporary closure of the abdomen or chest is also justified.
Unlike the damage control surgical tactics, the indications for abbreviated surgery are not based on the patient's physiology but on the hospital's rules for mass casualty events.
Abbreviated surgery has the same principles as damage control tactics.
It is a surgical strategy that refuses the completeness of operations in favor of a physiological approach.
Its main advantage is speed and limited procedures to control injuries.
As with damage control tactics, more patients can be operated on by reducing the operating time, thus optimizing the available resources.
For more on emergency care, please watch other videos in our series.
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