Zaka Ullah Malik, Muhammad Salim, Muhammad Pervez, Muhammad Shoaib Hanif, Muhammad Tariq, Tahir Masood, Aqeel Safdar.
Management of gunshot and blast injuries after a suicidal terrorist attack in a closed space.
J Pak Orthop Assoc Jan ;21(1):55-61.

Objective: The purpose of this study was to assess the pattern and nature of injuries sustained in a close space by terrorist attack and to analyze the management of mass casualties in such incidence. It is a descriptive study carried out at Combined Military Hospital Quetta Pakistan. Patients and Methods: This study included patients who reported to the hospital after being injured in terrorist attack on a mosque. Hospital disaster plan was initiated. “Triage Sieve” was used to prioritize the patients into priority I, II, III and IV. Serious patients were further prioritized for surgery using trauma index. Initial phase of surgery was focused upon life and limb saving followed by wound debridement / definitive treatment. Data was recorded and analyzed statistically. Results: Total number of casualties was 94 out of which 43 were brought in dead, and 51 were admitted to the hospital. Mean age was 30.39 + 14.59. Maximum patients were of gunshot wounds that were 78.4%. The cases were categorized as Priority-I 13.8%, Priority-II 10.6%, Priority-III 29.8%, and Priority-IV 45.8%. Total reception time was less than one hour. Mean Trauma index in priority I patients was 15.15+ 5. One patient with trauma index 24 could not be resuscitated and another patient with same trauma index died in hospital postoperatively. Conclusion: Close range firing by automatic rifles and blast injuries cause lot of deaths at spot especially in a suicidal attack. The survivors in priority I having serious injuries were mainly due to Gunshot wounds and in priority II and III having minor injuries were mainly due to splinter injuries. Prompt hospital response, appropriate triage, and efficient surgical approach decreases mortality rate especially in salvageable injuries.

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