Monash surgeon calls for new terrorist attack treatment measures

Professor Jeffrey Rosenfeld during his last military deployment

by Anne Crawford

A leading military surgeon says Australian hospitals should become familiar with US military trauma guidelines to better prepare them for terrorist attacks or other mass casualty events.

Professor Jeffrey Rosenfeld, a senior neurosurgeon at The Alfred Hospital, Professor of Surgery at the Monash University and a Major General in the Australian Defence Force, is also calling for civilians to be trained in haemorrhage control through the ‘HemCon’ course developed by the American College of Surgeons and the Hartford Consensus in the US, recommendations made after a US school shooting in late 2012 in which 20 children were fatally shot.

Professor Rosenfeld was elaborating on comments made in a paper recently published in Emergency Medicine Australasia, co-written with Alfred trauma specialists including Professors Mark Fitzgerald and Biswadev Mitra, and senior Australian military medical specialists and leaders in ambulance services.

Professor Rosenfeld, who has been deployed as a military surgeon in Iraq and other war zones, said the type of trauma that occurs in war zones and terrorist events is very different from the blunt trauma seen in hospital emergency departments.

“Bomb blast injuries cause a lot of internal damage to the organs and various structures in the body. If you’re close to the blast you’ve got penetrating injury where metal, foreign material like concrete, dirt or clothing go in all different directions through internal parts of the body. Then there are hot air blasts and burns, and injuries to lungs which may make it difficult to ventilate a patient.

“We can’t assume that people working in hospitals know about all of this.”

Professor Rosenfeld said the US military had made major improvements in trauma care in the past 15 years through lessons learnt in Iraq and Afghanistan. He would like its Tactical Combat Casualty Care Guidelines adapted for use in Australia.

“The highest survival rates of all military hospitals in history were achieved by using these protocols,” he said. “We don’t need to reinvent the wheel.”

All Australian states now have comprehensive emergency plans with pre-hospital services and emergency departments at high levels of readiness for disaster response and mass casualties, the paper said. These events include bushfires, such as the deadly fires in 2009, and the ‘thunderstorm asthma’ epidemic in November 2016.

“We have various trauma protocols in Australian hospitals and separate disaster protocols but that we need more consideration of the management of blast injury and penetrating ballistic trauma.”

Few bomb blast attacks have occurred in Australia to date, nevertheless the country is now on a ‘moderate’ terrorist threat watch and health professionals need to be prepared to treat mass casualties with blast and ballistic trauma according to military principles, Professor Rosenfeld said.

Training could include also burns management and the decontamination and treatment of chemical weapons victims.

Professor Rosenfeld said tourniquets and combat gauze designed to stop life-threatening haemorrhages used by the US military should be made available to first responders including ambulance paramedics, volunteer firefighters, the public and in life-saving clubs for shark attack injuries.

“Bleeding to death is one of the big killers in critical situations,” he said.

Information about how to use the tourniquets should be introduced to first-aid training courses such as St John’s Ambulance, and inexpensive kits containing them placed in the same areas as defibrillators, he recommended.

“These are very simple, very inexpensive measures. Once you roll them out and educate people you will save a lot of lives,” Professor Rosenfeld said.

Rosenfeld JV, Mitra B, Smit V, Fitzgerald MC, Butson B, Stephenson M, Reade MC. Preparedness for treating victims of terrorist attacks in Australia: Learning from recent military experience. Emerg Med Australas. 2018 May 9. doi: 10.1111/1742-6723.13091. [Epub ahead of print]