Grim Realities: Encountering Battlefield Casualties

Dr Gamani Goonetilleke, whose chosen title is “Treating war victims: a learning experience” ….. https://drgamini.org/2020/07/13/first-exposure-to-war-injuries/

As a medical student or as a doctor, I was never taught about War injuries, their implications or the principles of their management. Nor did I study the topic. We grew up and learnt medicine and surgery during peaceful times when these were not seen. The initial exposure to these gruesome circumstances was dreadful and horrendous. It was my duty to attend to these casualties as they were brought to hospital.

Legs amputated by blast

Land mine explosion

Suddenly one morning in July 1985 a landmine buried on the main road between Polonnaruwa and Batticaloa was exploded by the terrorists at a point called Punani as an army jeep carrying six soldiers passed over it.  The six victims of a landmine blast were brought to the Polonnaruwa Hospital. They were soldiers of the Sinha Regiment of the Sri Lanka Army. Three were dead on admission with mutilated bodies. The others had major injuries. It was my duty to do something that I’ve never even seen done. The typical surgical educational quip is see one, do one, teach one ……. but I hadn’t even seen one. I treated the three soldiers who were injured. Following the basic principles of surgery, I knew I had to save life first and then save the limb afterwards. I attended to them to the best of my ability with the basic facilities and staff that were available to me.

This was just the beginning. With time, there was more and more violence and more casualties being admitted to the hospital. We had to be prepared as a team to attend to any number and any type of casualty that was brought in. My staff at the hospital gave me full support. We learnt about Triage, which is the sorting of casualties and their treatment according to the severity of the injury. We also learnt how to attend to mass casualties. Being the most senior doctor there at that time I was the Triage Officer and I had to decide the priorities of care.

Mutilated body

The explosion of bombs caused mutilating injuries and devastation. Many casualties were admitted simultaneously. Some were in a state of shock, others were dead on admission. There were also victims with burns caused by the heat generated by the explosion. These were extensive burns and the patients were admitted in a state of shock, requiring urgent and active resuscitation. Shrapnel incorporated in the explosive device or those from the surrounding areas, like pieces of glass, wood, brick, masonry etc, caused penetrating injuries of the body affecting the head, trunk and the limbs; These, too, required urgent surgery.

 Blown up jeep

Land mines

The management of war injuries at this Base Hospital was a learning experience. It was a case of learning on the job and also educating myself and others in my team about the correct management of these injuries. But how? There were no computers, and no internet …… let alone smart phones or a reference library. I had to get back to the bookshelf at the library 240 km away in Colombo and reach out to books and articles on war injuries. I learnt the correct techniques that should be employed in managing these injuries. This no doubt added to my surgical experience which I would not have gathered in any other hospital except in a hospital treating war casualties.

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Dr Gamini Goonetilleke

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PERTINENT EMAIL MEMO from Dr Suren Paul (in UK now), dated 10 June 2021:

Thank you! I too had similar experiences working in the Accident service in Colombo. I treated the soldiers helicoptered in to Colombo after the attack by the LTTE on the Yarl Devi train. I applied the Triage system first used By Baron Larrey, Napoleon Bonaparte’s Surgeon at the Battle of Waterloo. I did the triage myself even though at the time I was only a Resident Surgeon recently returned form the UK. The Senior Consultants of the General Hospital did not have a clue. I also got down the Medical Supernitendent of the Hospital, Dr Lucian Jayasuriya. As  a consequence, later on, a disaster plan was formulated for the Mass casualty situation.

Incidentally while I had access to  British textbooks of Surgery I found they were completely useless. British surgeons at the time had very little exposure to major Trauma at the time. Even today there is comparatively little Trauma in the UK. British roads are the safest in the world. Even the Germans are studying the Motorway systems in this country! There is really no Gun culture unlike the US and there is Strict health & safety legislature since 1974. The only experience of terrorism was confined to Northern Ireland in the ’70s. In contrast the US & South Africa have had a lot of trauma experience  and I relied a lot on books and articles from those countries.

I developed quite an experience in my 5 years at the Accident Service, Colombo. {So much so that] I was able to collect 50 cases of all sort of liver injuries and submit it for a Hunterian Lecture at the Royal College of Surgeons of England.

I am now a member of the Asian trauma collaboration and we have frequent meetings  thanks to Zoom. Trauma is a major problem in Asia with motor vehicle collisions and the lack of a safety culture. The situation is exacerbated from time to time by war and insurgency.