Military medicine
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During the war in Croatia, antipersonnel mines were mostly laid without plan by both sides, with no minefield layout, especially on the East Slavonia front. A group of Croatian disabled war veterans wounded by antipersonnel mines at the East Slavonia front from June 1, 1991, to September 1, 1992, were analyzed. The front line between the Croatian Army units and Serbian paramilitary units mostly ran along a lowland, partially swampy and wooded ground, convenient for large-scale laying of antipersonnel mines, especially so-called surprise mines. ⋯ A failure to comply with minelaying regulations made protection impossible and resulted in a relatively high proportion of the wounded. The same problems are now encountered on mine removal. According to estimates, at least 10 years of intensive work of 2,000 to 3,000 trained experts will be required to clear some 2 million mines laid all over the area.
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This paper outlines the causative factors, incidence, and localization of extremity amputations of wounded persons treated at the Osijek University Hospital (Eastern Slavonia) during 1991 and 1992. The medical documentation of 5,024 patients was analyzed. Of these, 1,560 patients were treated in the hospital (31.0%). ⋯ Secondary amputations (on the lower extremities) were performed on 2 patients because of vascular insufficiency. Not a single secondary amputation procedure was performed because of infection, secondary uncontrolled hemorrhage, or gas gangrene. Amputation is a radical and irreversible intervention, and indications for amputation must be determined by those with great surgical experience and good knowledge of military-surgical doctrine.
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Combat medics play a significant role in any fighting unit. In recent years, during times of peace and low-intensity military conflicts, as well as in operations other than war, reserve combat medics have been challenged to treat major casualties in the field. Although this work requires important manual skills, the medics perform basic treatment maneuvers that are not necessarily for saving of lives. ⋯ Not all medics are exposed to major trauma, but for those who are, the numbers of patients per medic is not large. Therefore, the need to educate the medics in cognitive, and more importantly, in manual skills, is obvious. Suggestions for the means to do so are provided.
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This investigation was performed in Zagreb and its surroundings in 1991 and 1992 during the war against Croatia. The study included 50 civilians who, at the moment of the sounding of the air-raid siren, had a continuous electrocardiogram recorded as part of the routine cardiologic examination. The frequency of the pulse was read out from the electrocardiogram at four different times: before the sounding of the siren, the moment of the sounding of the siren, the moment of cessation of the alert, and 1 hour afterward. ⋯ However, no significant difference was found between the beginning and the end of air-raid alert campaign (p > 0.05). We conclude that within the civilian population of the city of Zagreb there was no adaptation to traumatic war situations as indicated by a lack of pulse reaction after a period of time under air-raid alerts. In other words, civilians always reacted with increased pulse frequency at the moment of the sounding of the air-raid siren.
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Historical Article
Early pulsatile lavage for the decontamination of combat wounds: historical review and point proposal.
Pulsatile lavage is an effective means of irrigation for grossly contaminated wounds. Pulse lavage was first used by oral surgeons in the U. S. ⋯ S. military investigators pioneered its early development and scientifically validated its efficacy. Modern pulse lavage units are ideally suited for military use because they enable first- and second-echelon medical personnel (including nonphysicians) to rapidly and effectively decontaminate combat wounds with minimal logistic burden. Pulse lavage units should become standard issue in all combat medical supply canisters or Authorized Medical Allowance blocks, and medical personnel should be trained in their use.