Ballistic Trauma(1).pdf

Ballistic Trauma

Second Edition

Ballistic Trauma

A Practical Guide

Second Edition

Edited by

Peter F. Mahoney, James M. Ryan, Adam J. Brooks

and C. William Schwab

Project Coordinators

Miranda Dalrymple and Cara Macnab

With 161 Illustrations

Foreword by Martin Bell

Peter F. Mahoney, OStJ, TD, MSc, MB BS, FRCA, FFARCSI, FIMC RCSEd, DMCC,

RAMC

Defense Medical Service and Leonard Cheshire Centre, Royal Free and University

College Medical School, Academic Division of Surgical Specialities, London, UK

James M. Ryan, OStJ, MB, BCh, BAO, MCh, FRCS, DMCC, FFAEM

Leonard Cheshire Centre, Royal Free and University College Medical School,

Academic Division of Surgical Specialities, London, UK

Adam J. Brooks, MB, ChB, FRCS (Gen Surg), DMCC, RAMC(V)

Department of Surgery, University of Pennsylvania School of Medicine, Division of

Traumatology and Surgical Critical Care, Hospital University of Pennsylvania,

Philadelphia, PA, USA

C. William Schwab, MD, FACS, FRCS (Glasg)

Department of Surgery, University of Pennsylvania School of Medicine, Division of

Traumatology and Surgical Critical Care, Hospital University of Pennsylvania,

Philadelphia, PA, USA

British Library Cataloguing in Publication Data

Ballistic trauma : a practical guide.—2nd ed.

1. Gunshot wounds 2. Penetrating wounds

I. Mahoney, Peter F.

617.1¢45

ISBN 185233679X

Library of Congress Cataloging-in-Publication Data

Ballistic trauma : a practical guide/Peter F. Mahoney...[et al.].

p. ; cm.

Rev. ed. of: Ballistic trauma: clinical relevance in peace and war. 1997.

Includes bibliographical references and index.

ISBN 1-85233-678-1 (hardcover : alk. paper)—ISBN 1-85233-679-X (softcover : alk.

paper)

1. Gunshot wounds. I. Mahoney, Peter F.

[DNLM: 1. Wounds, Penetrating—diagnosis. 2. Wounds, Penetrating—therapy.

WO 700 B193 2004]

RD96.3.B355 2004

617.1¢45—dc22

2004050435

ISBN 1-85233-678-1 (hardcover) ISBN 1-85233-679-X (softcover) Printed on acid-free paper

First edition, Ballistic Trauma: Clinical Relevance in Peace and War (0340581144), published

by Arnold, 1997.

Apart from any fair dealing for the purposes of research or private study, or criticism, or

review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may

only be reproduced, stored or transmitted, in any form or by any means, with the prior per-

mission in writing of the publishers, or in the case of reprographic reproduction in accordance

with the terms of licenses issued by the Copyright Licensing Agency. Enquiries concerning

reproduction outside those terms should be sent to the publishers.

The use of registered names, trademarks, etc., in this publication does not imply, even in

the absence of a speciﬁc statement, that such names are exempt from the relevant laws and

regulations and therefore free for general use.

Product liability: The publisher can give no guarantee for information about drug dosage and

application thereof contained in this book. In every individual case the respective user must

check its accuracy by consulting other pharmaceutical literature.

Printed in the United States of America (BS/EB)

987654321

SPIN 10887535 (hardcover)

SPIN 10887543 (softcover)

Business Media

springeronline.com

Springer Science

Foreword

This is a book ﬁrst and foremost for surgeons and those who work with

them in the management of ballistic trauma and treatment of its victims.

But the book is also of value to others with front-line experience and an

interest in the issue of harm reduction, whether in war or “peace,” on the

ﬁeld of battle or at the scene of a crime. These pages can also be studied

fruitfully by politicians, most of whom lack medical or military expertise,

in helping them understand the real world consequences of the decisions

that they make. (My own special interest, cheerfully declared, is that of a

beneﬁciary—having once been hit by mortar ﬁre as a war reporter, I am

grateful for the care of the surgeons and nurses who so expertly put me

back together again and returned me to front-line duty).

I believe that we live in the most dangerous times since the global warfare

of the mid-twentieth century. Appropriately, the editors of this book have

set their remit wider than the most recent advances in the relevant ﬁelds of

medical science—necessary advances—to keep pace with those in ballistic

science, as man ﬁnds ever more ingenious ways of killing and maiming his

own kind.

Napoleon III is reputed to have declared, “The history of artillery is the

history of progress in the sciences, and is therefore the history of civiliza-

tion.” I wonder, where does that leave us in the early twenty-ﬁrst century?

Nowhere very civilized, for sure.

In their preface to the ﬁrst edition, in 1997, the editors noted: “The lesson

of history is that you cannot take the experience of an urban hospital onto

the battleﬁeld. It also can be said, that you cannot do the reverse, and nowa-

days there is further confusion from the deployment of troops to peace-

keeping duties performed under the scrutiny of the media. The latter is not

the same as war.”

A great deal has happened since then, including the events of 11 Sep-

tember 2001, to change or qualify that judgment. Civilian and military

targets are attacked, not only by insurgent and revolutionary forces, without

distinction, discrimination, or regard to the Geneva Conventions. The front

lines are everywhere and all around us, as much in the concrete defences

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