Powerful bomb exploded in Hyderabad took over 16 lives and about 200 or more have been injured.These accidents now appears to be part and parcel of our living in a country like us where intelligence failure politicisation of police,lethargic and sluggish security arrangemts,or delayed and prolonged judiciary,easy manipulations of facts and evidences by Accused paying bribery to police,politician,press,witness and judiciary with nothing happening to Administration,government after accidents,are so commonly present that at every step whether in or out the home we are threatened with such attacks.
BY;------Dr,D,R,Nakipuria,Senior Physician,Dr.Ranju Nakipuria,Senior Gynaecologist
1420,mahagun Milano,crosing Republik,07838059592,07503303359
Therefore to educate common man,NGOs,paramedics and Doctors ,some common guidelines are being written from views of medical experts and committees of Disaster management and TRIAGE of national and international repute as r how to handle bomb explosions or terrorist attacks.
SOME COMMON PRINCIPAL IS TO SHIFT THE VICTIMS TO NEARBY HOSPITAL,NURSING HOME,PRIMARY HEALTH CENTRES AS SOON AS POSSIBLE RATHER THAN DOING SOMETHING AT SITE,AND FIRST OF ALL TRANSFER OR TAKE WITH YOU IN YOUR VEHICLE OR AMBULANCE FIRST THOSE LESS SERIOUSLY AFFECTED SO THAT THEY CAN BE COMPLETLY SHIFTED AND THEN SHIFT TO SERIOUSLY INJURED PATIENTS TRY TO TAKING FULL PRECAUTIONS TO DAMGE LESS INJURY TO THEIR INJURED PARTS PARTICULARLY SPINE-BACK,HEAD AND LIMBS.IF GOOD EQUIPPED AMBULANCES START FLUID,BLOOD AND OXYGEN AND PRIMARY LIFE SAVING MEDICINES IN AMBULANCES OR IF AIR LIFTING POSSIBLE THEN PLEASE UNDERTAKE THAT BUT WITHOUT ANY DELAY OF WAITING OF GOOD AMBUANCE,DOCTORS,MEDICATION,HELICOPTER ETC.PLEASE DONOT ASSEMBLE THERE TO SEE WHAT HAPPENED,TO TAKE PICTURES OR LIVE TELECASTING,DONOT CREATE CHAOS AND PANIC AND SPREAD RUMORS,DONOT THROW WATER TO EXTINGUISH FIRE,HELP POLICE,BOMB SQUADS,FIRE PERSONNELS AND MEDICAL TEAMS BY ARRANGING MORE AND MORE SERVICE RENDERING PERSONS,NGOS TO SHIFT VICTIMS AS SOON AS POSSIBLE.
FEW POITNS HAVE BEEN MENTIONED AS FOLLOWS;------------
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Half of all early casualties seek medical care over first hour. To know the total number of casualties, double this number after one hour. This formula is often used by the media and the authorities to predict the tolls. It is also useful to predict demand for care and resource needs.
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The most severely injured arrive after the less injured who need transport to the closest hospitals, so always expect upside down triage.
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It is important that we as doctors know how bomb blast cause injuries in order to tackle its repercussions of bomb blasts.
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Bomb blast injuries can be categorized into four types:
- Primary blast injuries are a direct result of the impact of the over pressurized blast wave on the body. It involves injuries to the hollow gas filled organs like the lungs, ear drum or intestines leading to their rupture.
- Secondary blast injuries occur due to flying debris and bomb fragments causing penetration or penetrating injuries to organs such as eyes.
- Tertiary blast injuries occur when individuals are thrown by the blast wind leading to fractures due to the fall.
- Quaternary blast injuries are due to direct effect of burn or crush injuries.
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The most important aspect is not to waste energies and resources on patients with non-serious injuries.
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Look for eardrum rupture and signs of respiratory imbalance. Their absence indicates a non serious injury.
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If the ear drums are intact, the patient can be discharged with first aid treatment.
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If ear drum is ruptured, immediately do an X ray chest. Keep the patient under observation for eight hours as primary blast injuries may have a delayed presentation.
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Otoscopic ear exam is the screening procedure for triage. Decreased oxygen saturation on pulse oximetry signals early blast lung injury, even before symptoms become apparent.
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Doctors should therefore focus only on two exams: otoscopic ear exam and pulse oximetry. Blast lung injury is unlikely without tympanic or ear membrane rupture.
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With the increasing use of explosives in terrorist events in our country in recent times, doctors, especially Emergency Doctors, should undergo orientation training every six months so that they are prepared and better equipped to manage several casualties all at one time.
- Emergency operations after resuscitating patient in icu with blood and other necessary investigations should be undertaken without waiting for relatives arrivals to save the life as soon as possible.
- More and more persons should reach to nearby these hospitals to donate Blood.
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drn
