Blast triage importants by dr k k Aggarwal

Feb. 23, 2013 - PRLog -- Two powerful bombs that exploded in Hyderabad yesterday took over 15 lives. Heart Care Foundation of India and eMedinewS today released guidelines on how to handle a bomb explosion for the medical practitioners and the public.

Releasing the guidelines Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal President Heart Care Foundation of India and National Vice President Elect Indian Medical Association said that half of all the early casualties seek medical care within the first hour. To know the total number of casualties, double this number after one hour. This formula is often used to predict the death toll. It is also useful to predict demand for care and resource needs.

The most severely injured arrive after the less injured who need transport to the closest hospitals, so always expect an upside down triage.

It is important that we as doctors should know how bomb blast cause injuries in order to tackle its repercussions of bomb blasts. Bomb blast injuries can be categorized into four types:

·        Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. This involves injuries to the hollow gas filled organs like the lungs, ear drum or intestines leading to their rupture.

·        Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.

·        Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.

·        Quaternary blast injuries are due to direct effect of burn or crush injuries.

 The most important aspect is not to waste energy and resources on patients with non-serious injuries.

When a patient of blast injury comes in, the triage doctor should look for only two things, an eardrum rupture with an otoscope and signs of respiratory imbalance using the pulse oximeter. If the ear drums are intact, the patient can be discharged with first aid treatment. Blast lung injury is unlikely without tympanic or ear membrane rupture.

If ear drum is ruptured, do an X-ray chest immediately and keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.

With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time, added Dr Ramesh Hotchandani incoming president IMA New Delhi Branch.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 29805 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

About the author: Padmashri & Dr. B.C. Roy National Awardee, Dr. KK Aggarwal is a Senior Consultant, Physician, Cardiologist at Delhi based Moolchand Medcity; President Heart Care Foundation of India; Chairman Ethical Committee Delhi Medical Council and has served as the Research and Academic Wing Heads of National Indian Medical Association.