PubMed Health⌕ Search

Biomedical subjects

R M Coupland

Publications and source records attributed to R M Coupland.

At least 19 recordsLinked to original sources
PubMed1999

Mortality associated with use of weapons in armed conflicts, wartime atrocities, and civilian mass shootings: literature review.

OBJECTIVE: To determine the implications of variation in mortality associated with use of weapons in different contexts. DESIGN: Literature review. SETTINGS: Armed conflicts and civilian mass shootings, 1929-96. MAIN OUTCOME MEASURE: Mortality from wounds. RESULTS: During the fighting of war the number of people wounded is at least twice the number killed and may be 13 times as high; this ratio of the number wounded to the number killed results from the impact of a weapon system on human beings in the particular context of war. When firearms are used against people who are immobilised, in a confined space, or unable to defend themselves the wounded to killed ratio has been lower than 1 or even 0. CONCLUSIONS: Mortality from firearms depends not only on the technology of the weapon or its ammunition but also on the context in which it is used. The increased mortality resulting from the use of firearms in situations other than war requires a complex interaction of factors explicable in terms of wound ballistics and the psychology of the user. Understanding these factors has implications for recognition of war crimes. In addition, the lethality of conventional weapons may be increased if combatants are disabled by the new non-lethal weapons beforehand; this possibility requires careful legal examination within the framework of the Geneva Conventions.

Civil Disorders↗
PubMed1999

Effect of type and transfer of conventional weapons on civilian injuries: retrospective analysis of prospective data from Red Cross hospitals.

OBJECTIVE: To examine the link between different weapons used in modern wars and their potential to injury civilians. DESIGN: Retrospective analysis of prospectively collected data about hospital admissions. SETTING: Hospitals of the International Committee of the Red Cross. SUBJECTS: 18 877 people wounded by bullets, fragmentation munitions, or mines. Of these, 2012 had been admitted to the hospital in Kabul within six hours of injury. MAIN OUTCOME MEASURES: Age and sex of wounded people according to cause of injury and whether they were civilians (women and girls, boys under 16 years old, or men of 50 or more). RESULTS: 18.7% of those injured by bullets, 34.1% of those injured by fragments, and 30.8% of those injured by mines were civilians. Of those admitted to the Red Cross hospital in Kabul within six hours of injury, 39.1% of those injured by bullets, 60.6% of those injured by fragments, and 55.0% of those injured by mines were civilians. CONCLUSIONS: The proportion of civilians injured differs between weapon systems. The higher proportion injured by fragments and mines is explicable in terms of the military efficiency of weapons, the distance between user and victim, and the effect that the kind of weapon has on the psychology of the user.

Adolescent↗
PubMed1994

Epidemiological approach to surgical management of the casualties of war.

The nature of modern conflicts precludes adequate medical care for most people wounded in wars. The traditional military approach of echeloned care for those wounded on the battlefield has limited relevance. I present an alternative, epidemiological approach whereby some effective care may reach many more. For a surgical facility to have a positive impact by using surgical and anaesthetic competence there must be access to the wounded; security for staff and patients; and a functioning hospital infrastructure. These all depend on respect for the first Geneva convention. Early hospital admission for urgent surgery is not so important if there is adequate first aid beforehand. The hospitals of the International Committee of the Red Cross have provided surgical care for thousands of wounded people by fulfilling these conditions. People wounded in modern conflicts would fare better if these priorities were recognised and less emphasis was placed on the more spectacular aspects of surgical care that benefit only a few.

Epidemiologic Methods↗
PubMed1994

War wounds of bones and external fixation.

Missile and explosive limb wounds associated with fractures are common in warfare. The retrieval of function is determined more by the nature of the wound and the wound management than by the method of fracture immobilization. The wound must be managed according to well-proven basic principles and then the advantages and disadvantages of the different methods of fracture immobilization considered for each individual patient. Before embracing external fixation as an indispensable tool for managing war wounds, one must recognize that its popularity in civilian practice is founded on its use for severe open tibial fractures from road trauma. Its principle advantage is to permit access to the soft tissue wound whilst the severity of possible disadvantages is not recognized; its effect on bone healing remains unclear. This review examines the role of external fixation in the management of war wounds and advises caution when considering its widespread or universal use. An approach to war wounds with fractures is described whereby external fixation can be combined with plaster splints or traction; this draws on the advantages of both operative and non-operative methods of fracture immobilization and eliminates many of the disadvantages.

Bone and Bones↗
PubMed1993

Hand grenade injuries among civilians.

OBJECTIVES: To describe how noncombatants are injured by hand grenades in camps for displaced people, and to categorize grenade wounds according to the Red Cross wound classification. DESIGN: Case series. SETTING: A surgical hospital in Khao I Dang refugee camp on the Thailand-Cambodia border. PATIENTS: Seventy-four patients injured by hand grenades. INTERVENTIONS: Intravenous antibiotics and primary wound surgery. MAIN OUTCOME MEASURES: Combatant status of the patients, categorization of the wounds, surgical outcome, number of operations, and number of blood transfusions. RESULTS: Only 7% of the patients sustained their wounds in battle and 50% were women, children, or older men. Seventy had 91 wounds that could be categorized; 59% of the wounds were small, affecting only soft tissue. Few wounds were associated with fractures and none with comminuted fractures. Twenty-four soft-tissue wounds were treated conservatively with minimal morbidity and no mortality. CONCLUSIONS: Missiles (fragments or bullets) from hand grenades tend to produce wounds with little tissue damage. Serious injury is due to penetration of vital structures. The results permit a recommendation that certain small and uncomplicated fragment wounds can be treated initially without surgery.

Adolescent↗
PubMed1992

Assessment of bullet disruption in armed conflicts.

Under international humanitarian law, the Hague Declaration of 1899 forbids the use of small arms ammunition that disrupts in the body after impact. However, assessment of whether bullets have undergone disruption is subjective and accusations that one or both sides of a conflict have used such ammunition cannot be substantiated. We describe a method by which disruption of bullets after impact can be assessed objectively. We reviewed 1287 wound radiographs of 1201 patients in four International Committee of the Red Cross hospitals. Radiographs were scored according to the F (fracture) and M (presence of metallic bodies) variables of the Red Cross wound classification; bullet disruption is evidenced by metallic fragments on the radiograph. One hospital had a significantly higher proportion of patients wounded by bullets that disrupted after impact; these wounds were associated with comminuted fractures. The findings show that the presence of metallic fragments on a radiograph is a reliable indicator of wound severity and bullet disruption. The study has important implications for the upholding of international humanitarian law, because with our method the use and manufacture of bullets that contravene the Hague Declaration can be identified.

Foreign Bodies↗
PubMed1992

Craniocerebral war wounds: non-specialist management.

The non-specialist management of 28 craniocerebral war wounds is described. Of these, 26 were operated upon of which three died. Two of the survivors developed wound abscesses in the early postoperative period. None developed epilepsy while in hospital. Aspects of the operative management are discussed.

Afghanistan↗
PubMed1992

Triage of war wounded: the experience of the International Committee of the Red Cross.

The hospitals of the International Committee of the Red Cross are often faced with situations in which the number of war wounded requiring surgical attention overwhelms the available facilities. Hospital organization, equipment and changes of attitude necessary for health professionals are considered with respect to triage. Practical aspects of assessment and categorization of the wounded are considered in the light of a large experience; relocation and reassessment of those who do not warrant immediate surgery benefit patients and hospital staff alike. The importance of adherence to an emergency plan and respect for the decisions of the person in charge of the triage are emphasized. The difficult and stressful nature of triage of war wounded should always be taken into account.

Africa↗
PubMed1992

Transfusion requirements for the management of war injured: the experience of the International Committee of the Red Cross.

The quantity of blood required in the total surgical care of 4470 war injured patients in four hospitals was 44.9 units for every 100 patients admitted (u/cp). Patients evacuated to hospital in less than 6 h from wounding required 59.8 u/cp; patients admitted as a result of antipersonnel mines required 103.2 u/cp. Patients with burns potentially require most blood. Whether these figures permit prediction of transfusion requirements for future conflicts is discussed.

Afghanistan↗
PubMed1991

Injuries from antipersonnel mines: the experience of the International Committee of the Red Cross.

OBJECTIVE: To describe and quantify patterns of injury from antipersonnel mines in terms of distribution of injury, drain on surgical resources, and residual disability. DESIGN: Retrospective analysis. SETTING: Two hospitals for patients injured in war. SUBJECTS: 757 patients with injuries from antipersonnel mines. MAIN OUTCOME MEASURES: Distribution and number of injuries; number of blood transfusions; number of operations; disability. RESULTS: Pattern 1 injury results from standing on a buried mine. These patients usually sustain traumatic amputation of the foot or leg; they use most surgical time and blood and invariably require surgical amputation of one or both lower limbs. Pattern 2 injury is a more random collection of penetrating injuries caused by multiple fragments from a mine triggered near the victim. The lower limb is injured but there is less chance of traumatic amputation or subsequent surgical amputation. Injuries to the head, neck, chest, or abdomen are common. Pattern 3 injury results from handling a mine: the victim sustains severe upper limb injuries with associated face injuries. Eye injuries are common in all groups. CONCLUSIONS: Patients who survive standing on a buried mine have greatest disability. Non-combatants are at risk from these weapons; in developing countries their social and economic prospects after recovery from amputation are poor.

Amputation, Traumatic↗
PubMed1991

The role of reconstructive surgery in the management of war wounds.

Reconstructive surgery can be used within a framework of management of war wounds by basic principles. It falls into three groups: i. Primary (emergency) reconstruction; performed as part of initial surgery and as a life-saving procedure. ii. Delayed primary (essential) reconstruction; performed at the time of delayed closure. iii. Elective or non-essential reconstruction. All surgeons involved with the early management of war wounds should be prepared to perform primary and delayed primary reconstruction.

Emergencies↗