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Surgery Under Fire

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Book cover Surgery During Natural Disasters, Combat, Terrorist Attacks, and Crisis Situations

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Abstract

Performing surgery is often difficult. Performing surgery under fire is arduous at best. Furthermore, operating in dangerous or austere environments adds stressors uncommon to usual civilian practice. Yet, even for those surgeons that may never experience combat, circumstances may arise that can mimic this experience. As such, this chapter is applicable to all surgeons, especially in the world today, and outlines what a surgeon should consider when faced with taking care of an injured patient in less than ideal situations. There is much more to think about when dealing with traumatic injuries in an environment that is unsafe for all involved. While priority is always placed on treatment of the patient’s injuries, with the goals of saving life and limb, a surgeon operating under these conditions must also ensure his or her safety, as well as the safety of his or her team.

The tenets of damage control surgery in these situations are extremely important, and are explored here in this manuscript with an emphasis on peripheral vascular injuries. While primary repairs and grafting are the surgical standards to manage these types of injuries, often the patient’s physiology or the ever-evolving situation outside your tent or makeshift operating room do not allow for lengthy definitive operative repair. In these cases, shunting, ligation, or even amputation may be the best option at the time.

Finally, we discuss the effects of stress on the surgeon who finds it necessary to care for and operate on patients in these types of challenging environments. While we all like to think we are unflappable and have steeled ourselves over years of tough surgical training to handle the pressure of unusual and difficult situations, this stress can potentially have acute and/or cumulative effects on our cognitive and technical performance. Learning how you deal with stress and focusing on your mental health before, during, and after a traumatic experience can be beneficial both for you as the surgeon and for the patients who place their trust in you under dire and dangerous circumstances.

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Author information

Authors and Affiliations

  1. Department of Surgery, Madigan Army Medical Center, 9040a Fitzsimmons Dr., Fort Lewis, WA, 98431, USA

    George E. Black IV M.D.

  2. Department of Surgery, Division of Colorectal Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue Cleveland, Fort Lewis, OH, 44106, USA

    Scott R. Steele M.D., F.A.C.S., F.A.S.C.R.S.

Authors
  1. George E. Black IV M.D.
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  2. Scott R. Steele M.D., F.A.C.S., F.A.S.C.R.S.
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Corresponding author

Correspondence to George E. Black IV M.D. .

Editor information

Editors and Affiliations

  1. Department of Surgery, Advanced Laparoscopy and Metabolic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA

    COL Robert B. Lim

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© 2016 Springer International Publishing Switzerland

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Black, G.E., Steele, S.R. (2016). Surgery Under Fire. In: Lim, C. (eds) Surgery During Natural Disasters, Combat, Terrorist Attacks, and Crisis Situations. Springer, Cham. https://doi.org/10.1007/978-3-319-23718-3_16

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  • DOI: https://doi.org/10.1007/978-3-319-23718-3_16

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23717-6

  • Online ISBN: 978-3-319-23718-3

  • eBook Packages: MedicineMedicine (R0)

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