University of St Andrews Leads on Study on Emergency Conflict Care

A University of St Andrews medic has led a pioneering analysis of the surgical response to civilian victims of blasts and ballistics. The research was also partly funded by the University’s School of Medicine.

Dr Laura Maitland, who also works for NHS Highland, is the lead author of Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden: An observational study.

The study was supported by Dr Maitland’s supervisor, Professor David Harrison, School of Medicine, University of St Andrews, as well as Shehan Hettiaratchy, Imperial College, London; Lawrence Middleton; Harald Veen, Consultant, Netherlands Red Cross; and James Baden, University Hospitals Birmingham. The project used an observational study of 10,891 consecutive surgical cases of “civilian casualties that underwent primary trauma surgery for blast and ballistic injuries” (Maitland, Middleton, Veen et al., 2022).

Published in The Lancet eClinical Medicine, the work is “the largest record of primary surgical interventions carried out on civilian casualties injured from blast and ballistics during an armed conflict, in a paradigm of effectively a peace-time major trauma centre setting” (Maitland, Middleton, Veen et al., 2022).

The work looked at the care given to 983 civilians listed in log-books, revealing patterns in the care given to them. The work could potentially be used to create a template which would better standardize care responses to civilian victims of blasts and ballistics in the face of situations like terrorist attacks or civilians living in active war zones, such as Ukraine.

In the article, Dr Maitland said, “Terrorism and armed conflict cause blast and ballistic casualties that are unusual in civilian practice. The immediate surgical response to mass casualty events, with civilians injured by these mechanisms, has not been systematically characterised. Standardising an approach to reacting to these events is challenging but is essential to optimise preparation for them”.

“The primary aim of this study was to provide evidence to support clinicians to make decisions about the appropriate allocation of surgical resources for civilians injured in other armed conflicts, e.g., Ukraine, as well as MCE, where applicable”.

The study is meant to be a jumping off point for further research in understanding the most common and effective surgical responses to civilian casualties of blasts and ballistics. The study looked at types of injuries sustained, procedures underwent, adult vs pediatric casualties, gender differences in casualties, as well as outcomes to present a complete picture of the frequency and effectiveness of different treatments for specific injuries and demographics.

This information could be useful going forward in determining best practices of care for civilian casualties: “This study aims to support policy makers in making informed decisions about precisely what the medical needs are by providing stratified frequency tables to enable decision-makers to better determine the type and scale of the immediate surgical response required in armed conflicts, or in the immediate aftermath of a MCE, in order to deliver the right surgical procedures to save lives” (Maitland, Middleton, Veen et al., 2022).

Key findings of the study show that adult casualties of both blasts and ballistics are more common than pediatric casualties, and that no trauma casualties were female. Blast casualties were more common than ballistic ones (Maitland, Middleton, Veen et al., 2022).

Dr Maitland said, “This study provides a baseline/starter dataset and if we collect more data from other scenarios then we can understand how the battle space environment, e.g., weapons and geography, influences the data. This study enables the best template of the most likely injuries civilians may suffer in war/terror acts from blast and ballistic wounding mechanisms, and the most probable consequent surgical interventions”.

“These data can be used to better understand the immediate surgical response, to allocate resources, theatres and staff in major trauma events. These stratified frequency tables enable Emergency Preparedness, Resilience and Response planning for future acts of terror, industrial events and comparable conflicts using these wounding mechanisms”.

Maitland, L., Middleton, L., Veen, H., Harrison, D. J., Baden, J., & Hettiaratchy, S. (2022). Analysis of 983 civilian blast and ballistic casualties and the generation of a template of injury burden: An observational study. EClinicalMedicine, 54, 101676. https://doi.org/10.1016/j.eclinm.2022.101676

Image: University of St Andrews