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Oman - A Limited Experience

J.O. Soul

Journal of the Royal Naval Medical Services Vol 63 Summer 1977

The author deputised in September 1976 when the army surgeon was recalled

He defines the problems that arise as a result of the war and the presence of Adoo terrorists as

  • isolated skirmishes between border patrols from the Yemen and border patrols from the Sultan of Oman's Forces
  • occasional Adoo contact throughout Dhofar Province mainly in the jebel mountains
  • the presence of large numbers of anti-personnel mines planted during the war as yet uncleared and to a large extent uncharted.
  • road traffic accidents involving vehicles of the Sultan of Oman's Forces, usually Omani
  • isolated accidental discharges from weapons, burns and routine general practice
He notes that  " the only commodity not freely available was blood. This was so to bleed "on the hoof". If blood was required in an emergency for a major casualty, the requirement for the blood group was broadcast on Radio 219.... picked up on medium wave by all local expatriots.... at least 30 donors would attend within 10 minutes"

He describes five cases :

Case Report 1.
Thenar eminence injury in an Iranian Corporl from an accidental discharge

Case Report 2.
Forearm injury in an Iranian Sergeant. The same bullet that had injured Case 1

Case Report 3.
A Balouchi Sergeant who had stepped on an APM  and sustained a traumatic amputation of the left foot.

Case Report 4.
SAF Officer who had stepped on an APM and sustained the following injuries

  • traumatic amputation of the right leg
  • comminuted compound fracture of the right forearm with tissue loss
  • massive tissue loss
  • puncture wounds to the left hand
  • blast wounds to the posterior aspect of his left leg.

He was bleeding faster that fluids were being replaced even though he had several iv lines. Accordingly he was anaesthetised and a through knee amputation was carried out whilst resuscitation continued. Once his vital signs had improved surgical debridement continued. Wounds were packed with Chloros soaked packs. From a hole in his buttock the heel of his DMS boot was recovered.

Surgery lasted seven hours and he was transfused with 17 units of whole blood. He was evacuated to Queen Mary's Hospital at Roehampton after 48hrs.

Case Report 5
A Royal Engineer Sapper engaged in clearing a minefield who stepped on an APM. Seen 35 mins after injury with a traumatic amputation of the right foot and blast injuries to the left leg.

The right foot had been destroyed but the tiba and the fibula were intact. There was severe muscle damage with foreign bodies within the muscle planes  10cms higher than the level of major injury. DPS at four revealed a significant amount of de-vitalised tissue. Further debridement and tibia/fibula amputation was required and the wound was closed lightly around a pack and a pressure dressing was applied.

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In the discussion part of the paper he reflects on the reasons why so few people died.

  • The relatively small number of casualties seen at the FST
  • Their arrival singly rather than as a group

 

 

 

 

 

 

He reflects on the time taken from wounding to resuscitation

  • World War II       4  to  5 hours
  • Korea                     3       hours
  • Aden                      1.5 to 2 hours
  • Vietnam                 1.5 to 2 hours
  • Oman                     1.5 to 2hrs          
     

He comments that transit time from wounding to FST in Oman was about 35mins.

He observes that the length of time taken to anaesthetise and operate on the most severely wounded wound be unacceptable in a situation where there were a large number of casualties who not so severely wounded and could be saved.

He ruefully comments on the need for adequate primary debridement (Case 5)

He calls for more Naval Officers to be given the opportunity to gain FST experience.

 

Comment.

In Spring of '72 FST time from injury to surgery was 4.6 hours. This did include some very long waits in which people had been wounded up to thirty six hours before hand and could be refined rather than just taking the figures off the spreadsheet.

In the only experience that I have had of mass casualties - the RCL into the officers mess and the casualties from Mirbat - the most severely wounded can be saved and those waiting for surgery can be stabilised and supervised by FST members who are prepared to multi-task in a sometimes unorthodox way. See "Documents"   "The Technicians Tale".

In the Spring of 1972 it was not the policy to resuscitate the wounded and then proceed to surgery. Wounded only bleed more quickly as their blood pressure rises and with every unit of blood transfused the chances of clotting anomalies increases. Increased tendency to electrolyte imbalance may occur which is a problem if the means of assessing electrolytes is not provided. Time spent resuscitating the wounded is time when some useful surgery could be initiated and completed - you never know when the next casualty will arrive. If you fail to reach your ideal point where you declare them to be resuscitated you are then forced to anaesthetise them when they are in possibly a worse condition than when you started the resuscitation process. See Case 4 above. Resuscitation was combined with surgery which prevented further deterioration before electrolyte imbalance and coagulation defects had the chance to occur.; both anaesthesia and surgery were implemented as quickly as was practically possible. I admit to being of an impatient nature but the surgeon was pro-active as well!

FWJdeB