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PubMed1991

Preparing for war: lessons learned from U.S. Army flight nurses of World War II.

The combat posture of today's military forces, and more specifically the emphasis on medical readiness for members of the health care professions, shows that the involvement of flight nurses in armed conflict cannot be ruled out. As part of a larger study of how military nurses cope with war, 25 former U.S. Army flight nurses of World War II were interviewed to learn how they coped with wartime situations they perceived as taxing or exceeding their resources. The purpose of this paper is to describe those aspects of wartime nursing that flight nurses interviewed would like to have been different and, subsequently, what advice they would offer today's flight nurses. The responses are examined within the theoretical framework of stress, appraisal, and coping developed by Lazarus and colleagues.

Adaptation, Psychological↗
PubMed1991

[Experiences of war surgery from the civil war in Afghanistan].

The authors describe their experience of war surgery from a period of three months. A total of 635 patients, most of whom were young men, were treated. The journey to hospital was frequently very long, often lasting for several days. The lesions and types of surgery are described. Ketamine was found to be very useful for war anaesthesia.

Adolescent↗
PubMed1985

Rehabilitation outcome of combat head injuries: comparison of October 1973 War and Lebanon War, 1982.

A comparative study between two series of penetrating head injuries that occurred during the October 1973 (Yom Kippur) War and the Lebanon War, 1982, was conducted following the clinical impression that patients wounded in 1982 experienced shorter periods of unconsciousness. Patients in both series were of similar age and educational levels. Duration of coma was shorter, transfer to rehabilitation hospitals quicker and the overall hospital stay shorter, all significantly so, in the 1982 series. Other significant differences were the abundance of associated chest and abdominal injuries in the 1982 series and the fact that not a single patient underwent tracheostomy in the later series, in contrast to 64% of the 1973 patients. No differences were noted with regard to neurological sequelae, independence in activities of daily living, and high mental functions. Rehabilitation outcome, as evaluated by actual work placement, differed significantly in favor of the 1982 series. This was probably due to faster patient transfer to rear hospitals for definitive interventions, thus reducing secondary brain damage and resulting in shorter periods of unconsciousness.

Adolescent↗
PubMed1994

War injuries during the Gulf War: experience of a teaching hospital in Kuwait.

The war injuries of 361 patients admitted to Mubarak Al-Kabeer Teaching Hospital, during the Gulf War are reported. More abdominal and chest injuries were seen in this series in comparison with other conflicts owing to the short evacuation time. Of the injuries, 54% were caused by gunshots, 34% were fragment injuries and 5.5% were glass and stab injuries. Civilians accounted for 50% of the injured. Wound infection rate was 7%, average hospital stay was 8.8 days and hospital mortality was 5.5%. We advocate radical wound excision, exploration of penetrating wounds of neck and abdomen, and mainly conservative management of chest injuries that do not involve the mediastinum.

Abdominal Injuries↗
PubMed1995

War wounds in the Sibenik area during the 1991-1992 war against Croatia.

This report presents the analysis of war casualties treated at the Department of Surgery of Sibenik Medical Center during a 5.5-month period, i.e., from the beginning of the aggression in August 1991 to the international recognition of the Republic of Croatia on January 15, 1992. A total of 321 war casualties were treated, 157 of whom were out-patients and 164 in-patients with severe multiple injuries, 39.25% of the wounded were civilians, 10 of whom were children. Fragment wounds from mortar shells, anti-personnel mines, and infantry weapons were the most frequent type of injuries. The most common were injuries of the limbs. Gunshot injuries to the brain had the worst prognosis. Early management of the wounds was of special importance. Stabilization of the fracture using external fixators was indicated in patients with severe, complicated fractures associated with extreme defects of the tissue. Comatose patients with possible intra-abdominal injury presented a specific diagnostic problem, which was best treated by exploratory laparotomy. The overall mortality rate was 2.49%.

Adolescent↗
PubMed1994

American military dentists as prisoners-of-war in the Pacific theatre during World War II.

Fifty-three American Military dentists were held by the Japanese as Prisoners-of-War during World War II. Throughout 40 months of captivity these men served their fellow prisoners providing dental treatment in an austere environment with "jury-rigged" equipment and supplies. A brief overview of their experiences is presented in this paper.

History, 20th Century↗
PubMed1998

Mortality caused by war wounds to the head and neck encountered at the Slavonski Brod Hospital during the 1991-1992 war in Croatia.

From July 1, 1991, until January 1, 1993, a total of 7,720 patients (soldiers and civilians) with war wounds were treated at Dr. Josip Bencević General Hospital in Slavonski Brod, Croatia. Treatment was provided for 7,043 patients, whereas 677 individuals (8.8%) killed in action (KIA) were examined at the Forensic Department. There were 1,456 patients (18.9%) with head and neck wounds: 1,176 soldiers and 280 civilians. The mortality rate was significantly greater in patients with head and neck wounds (N = 271, 40.0%) than in those with injuries to the thorax (N = 163, 24.1%) and abdomen (N = 62, 9.2%; p < 0.01 for both). During treatment, 188 patients (2.4%) died of wounds (DOW). The DOW mortality was 5.2% (61 of 1,185), 4.0% (41 of 1,026), and 2.9% (25 of 867) for wounds of the head and neck, thorax, and abdomen, respectively. There was no significant difference in the mortality rate between head and neck and thorax wounds: however, the former exceeded the mortality rate recorded for abdominal wounds (p < 0.05). No significant differences were observed between soldiers and civilians with head and neck injuries either in the KIA (205 of 1,176, 17.4% vs. 66 of 280, 23.5%, respectively) or the DOW group (51 of 971, 5.3% vs. 10 of 214, 4.7%, respectively. According to the mechanism of head and neck wounding, there were 1,046 explosive (71.9%), 226 gunshot (15.5%), and 184 other (12.6%) wounds. Lethal outcome was significantly more common in gushot than in explosive wounds (79 of 226, 35% vs. 243 of 1,046, 23.2%; p < 0.01). The proportion of head and neck injuries did not differ significantly from literature reports on recent conventional wars. The site of wounding, i.e., at the battlefield or elsewhere, had no effect on the prognosis of wounds to the head and neck. Gunshot head and neck injuries showed a significantly higher mortality rate.

Abdominal Injuries↗
PubMed2005

Can epidemiology clear the fog of war? Lessons from the 1990-91 Gulf War.

Despite over US $200 million having been spent researching illnesses following the 1990-91 Persian Gulf War, the nature and cause of such illnesses remains controversial. In this narrative review, we discuss some of the methodological issues that have affected epidemiological studies on this topic. These include low-response rates, ascertainment bias, recall bias, problems identifying suitable control groups, and problems defining the outcomes to study. From this we argue that difficulties have arisen partly owing to the significant delay between the point at which illnesses were first identified by veterans and the reporting of epidemiological studies and that health surveillance should be routine following future deployments.

Congenital Abnormalities↗
PubMed1992

War crimes during the Persian Gulf War.

Evidence of violations of the 1949 Geneva Conventions by Iraq's military personnel during Desert Shield and Desert Storm are described and adverse effects on the Kuwaiti health care delivery system are discussed. New diplomatic and military initiatives that include education and accountability are needed to ensure better compliance with international conventions designed to protect victims of war.

Hospitals, Special↗
PubMed1996

Management of war-related neck injuries during the war in Croatia, 1991-1992.

From 1 September 1991 to 31 December 1992, a total of 7,043 wounded patients were treated in the War Hospital in Slavonski Brod. Seven hundred and twenty eight patients with head and neck injuries were treated in the Department of Otorhinolaryngology and Cervicofacial Surgery. Of this number, 187 had neck injuries. Ninety-two (49.2%) of them were treated in outpatient facilities and 95 (50.8%) as inpatients. Immediate exploration was done in 84 patients with penetrating neck injuries. Vital structures were involved in 49 patients: major blood vessels (40 cases), larynx (17 cases), pharynx (8 cases), trachea (5 cases), thyroid gland (3 cases) and esophagus (2 cases). Definitive treatment was given to all of these injuries. Primary wound closure was performed upon exploration in 74 patients who were treated within the first 6 h after trauma. Secondary wound closure was performed in 10 patients with neck exploration performed more than 6 h after injury, and in those with extensive defects of tissue requiring the use of larger local flaps or free flaps. The mortality among patients with neck injuries was 2.1%.

Adolescent↗
PubMed1998

Self-inflicted gunshot wounds to the head during the war and post-war period.

Thirty-five patients with self-inflicted gunshot brain injury were admitted to our hospital during 1991-96. War conditions and availability of firearms influenced the increase in these injuries, nearly six times greater than in the previous 6-year peace time period (1985-90). Our management protocol consisted of radical debridement of the missile track and evacuation of haematomata. For in-driven bone fragments we followed a less radical approach, but, if a post-operative computed tomogram (CT) showed a cluster of retained bone fragments, we operated on this. Attention was paid to the development of intracranial infection performing in such cases a contrast enhanced brain computed tomography. Ten patients died early and 29 were managed operatively. Twelve survived, and were followed-up for up to 60 months. No case of suicide recidivism was noted. We conclude that patients with a Glasgow Coma score of 3 should not be considered for operation. Per-operatively ultrasonography was very helpful in localizing and extracting in-driven bone fragments. Post-operatively, a CT scan is needed to demonstrate retained bone fragments.

Adolescent↗
PubMed1999

Testing a model of family stress and coping based on war and non-war stressors, family resources and coping among Lebanese families.

This study was undertaken to describe the objective stressors, perceived stress, coping, and resources of families living in Beirut during the Lebanese war (1975-1991) and to test a model predicting the relationships of these variables to family adaptation. The sample consisted of 438 families chosen at random. Independent variables included objective stressors and perceived stress. The mediating variables were family resources and coping strategies. The dependent variables were health and interactional indicators of family adaptation: physical and psychological health, depression, and interpersonal and marital relationships. Findings provided support for the theoretical framework. Multiple regression analyses revealed that perceived stress, rather than the objective occurrence of events, predicted family adaptation. Family resources, particularly social support, positively impacted family adaptation and was associated with increased use of cognitive coping. The findings provide a theoretical model which, on further testing, can serve as a basis for practice by health professionals when working with traumatized families.

Adaptation, Psychological↗
PubMed1991

Comorbidity of psychiatric disorders and personality profiles of American World War II prisoners of war.

To characterize the effects of trauma sustained more than 40 years ago, prevalence of psychiatric disorders and personality dimensions were examined in a sample of 62 former World War II POWs. The negative effects of their experiences are reflected in their multiple lifetime diagnoses and in their current personality profiles. Fifty percent met DSM-III posttraumatic stress disorder (PTSD) criteria within 1 year of release; 18 (29%) continued to meet the criteria 40 years later at examination (chronic PTSD). A lifetime diagnosis of generalized anxiety disorder was found for over half the entire sample; in 42% of those who never had PTSD, 38% of those with recovery from PTSD, and 94% of those with chronic PTSD. Ten percent of those without a PTSD diagnosis had experienced a depressive disorder, as had 23% of those with recovery from PTSD and 61% of the POWs with chronic PTSD. The combination of depressive and anxiety disorders also was frequent in the total sample (61%). Current MMPIs of three groups with psychiatric diagnosis were compared with those of POWs who had no diagnoses and with a group of Minnesota normal men. Profile elevations for the groups, from highest to lowest, were: POWs with chronic PTSD, POWs with recovery from PTSD, POWs with other psychiatric diagnoses, POWs with no disorders, and Minnesota normal men. Symptoms of anxiety, depression, and somatic concerns combined with the personality styles of suppression and denial characterize the current adjustment of negatively affected POWs.

Adaptation, Psychological↗
PubMed2006

When the war was over, little changed: women's posttraumatic suffering after the war in Mozambique.

This article explores the psychosocial effects of women's prolonged exposure to civil war in the center of Mozambique. Using a combination of quantitative and qualitative methods, 91 women were assessed for posttraumatic stress symptoms and psychosocial indicators of ill health. The results indicate that for the majority of the women in this study, traumatic experiences are sequential processes. Their ill health ranges from symptoms of posttraumatic stress to episodes of spirit possession (gamba), affecting women's capacities to conceive and raise children, and marginalizing their social position. A careful analysis of the specific problems and needs of women in postwar contexts is recommended, along with a systematic examination of the effectiveness of the available resources that may play a role in boosting trauma recovery in this group of women.

Adult↗
PubMed1989

Use of phenytoin in healing of war and non-war wounds. A pilot study of 25 cases.

Nineteen patients with war-related missile wounds and six with refractory civilian ulcers were treated with topical phenytoin sodium powder daily for up to 4 weeks. The mean healing time was 2 weeks for missile wounds, compared to historical controls requiring 6-8 weeks. Healing time was 4 weeks for civilian ulcers that had been unresponsive to any treatment over the previous 5 months. Twenty-two patients had complete healing, three required skin grafts. Wider use of this safe, inexpensive, readily available and easy-to-use agent is suggested because of its positive effect on wound healing and rapid pain relief.

Clinical Trials as Topic↗
PubMed1993

Insanity and war: the Gulf War and a psychiatric institution.

The threat of a chemical war has profound impacts on all layers of society. Hospitalized mental patients, as we have observed them, react in more extreme ways than staff members. They may react overanxiously, totally apathetically, or in context-related flights to partial sanity. Denial and projection were heavily used defense mechanisms together with a tendency of the more acute patients to plunge into their bizarre idiosyncratic world, lending strange meanings to what was happening in the world. Many patients were found to have strong narcissistic traits and to invest most of their libidinal energies in their private world. In times of stress this results in even greater social isolation. Different types of patients in different phases of their illness react differently to such overpowering stress, and the way they react illustrates their cognitive, behavioral, and social deficiencies. WWII literature on the reactions of mentally ill patients to "fly-bombing" seem not to take into consideration the different possible reactions of patients. This may be due to a change in emphasis in the care of mentally disturbed individuals in the last two decades. We propose to use even such an extremely stressful situation as a challenge to the mental health profession to further the well-being of their patients.

Adaptation, Psychological↗
PubMed1976

Modern war surgery: operations in an evacuation hospital during the October 1973 Arab-Israeli war.

A forward evacuation hospital functioned in the southern front in October 1973 Israeli-Arab War as an intermediate unit in the Israeli casualty management logistics. Casualties were characterized by frequent multiple-system injuries and variable combinations of penetrating wounds, blunt trauma, burns, and inhalation injury, with an increased incidence of associated blunt trauma. As the result of the systems organization, the EH was able to provide the wounded with early intensive and definitive resuscitation therapy which permitted further evacuation of the casualties to the central hospitals in a better state of physiological stability. In the most critically wounded when there was imminent threat to survival, operations were performed at the EH as an integral part of the resuscitation process. Performance of operations in a forward evacuation hospital did not increase the number or severity of postoperative complications. Morbidity and mortality were related to the nature and magnitude of injury.

Egypt↗