Since 1988, the ICRC has sought to capture the experience of surgeons working in war zones in the evolving textbook, Surgery for victims of war, to which a number of eminent British surgeons, including Mike Owen-Smith, Robin Gray and Robin Coupland, have contributed. This book is the latest incarnation of the multi-author series.
War Surgery drags surgeons from the mindset of unlimited resources in a modern civilian hospital to a dark place where operations are done by candle and torchlight, under canvas and moonlight, and where those casualties lucky enough to find a trained doctor may arrive after journeys of unimaginable torment. This book is an interesting hybrid, which is best understood as a manual for surgeons entering the ICRC or non-governmental organisation environment, needing to cross the boundary from the modern to a more primitive and disturbing world. In this world, treatment priorities are determined as much by the venom with which you are threatened by the Kalashnikov-armed, testosterone, adrenalin and ganja-fuelled child soldier as by high moral principles and where survival is a matter of negotiation. However, the lessons and principles described find much more general application and there are circumstances in which any surgeon or trauma team may need to apply them.
In 18 chapters, the book describes the special characteristics of healthcare provision in times of conflict. It provides a wealth of detail on humanitarian law; on mechanisms and epidemiology of conflict wounding; on the Red Cross wound score and wound classification systems; on the working of the casualty evacuation chain from the point of wounding; on hospital triage of mass casualties; on first aid and on ATLS® and emergency room care. It discusses the principles of the management of neglected, mismanaged and infected wounds; of retained bullets and fragments; of burn and cold injuries; and the principles of anaesthesia and analgesia for such cases. These chapters are richly illustrated with photographs and clear diagrams.
There is a chapter on modern understanding of the pathophysiology of trauma and the need to address hypox-ia, hypothermia, hypoperfusion and hypocoagulability. Any modern surgeon, who is serious about his or her craft and about dealing with the unwanted and unexpected, would do well to learn the lessons and wisdom encompassed in this latest rewriting of an excellent textbook.