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Snaquebite
08-16-2008, 10:50
I'm not a medic and haven't read this book, but knew some might be interested.

http://www.iht.com/articles/2008/08/05/healthscience/05surg.php

A surgeon's guidebook to the horrors of battle
By Donald G. Mcneil Jr.
Tuesday, August 5, 2008
The pictures show shredded limbs, burned faces, profusely bleeding wounds. The subjects are mostly American GI's, but they include Iraqis and Afghans, some of them young children.

They appear in a new book, "War Surgery in Afghanistan and Iraq: A Series of Cases, 2003-2007," quietly issued by the United States Army — the first guidebook of new techniques for American battlefield surgeons to be published while the wars it analyzes are still being fought.

Its 83 case descriptions from 53 battlefield doctors are clinical and bone dry, but the gruesome photographs illustrate the grim nature of today's wars, in which more are hurt by explosions than by bullets, and body armor leaves many alive but maimed.

And the cases detail important advances in treating blast amputations, massive bleeding, bomb concussions and other front-line trauma.

Though it is expensively produced and includes a foreword by the ABC correspondent Bob Woodruff, who was severely injured by a roadside bomb in 2006, "War Surgery" is not easy to find. There were strenuous efforts within the army over the last year to censor the book and keep it out of civilian hands.

Paradoxically, the book is being issued as news photographers complain that they are being ejected from combat areas for depicting dead and wounded Americans.

But efforts to censor the book were overruled by successive army surgeons general. It can be ordered from the Government Printing Office for $71; Amazon.com lists it as out of stock, but the Borden Institute, the army medical office that published it, said thousands more copies would be printed.

"I'm ashamed to say that there were folks even in the medical department who said, Over my dead body will American civilians see this," said Dr. David Lounsbury, one of the book's three authors. Lounsbury, 58, an internist and retired colonel, took part in the 1991 and 2003 invasions of Iraq and was the editor of military medicine textbooks at Walter Reed Army Medical Center.

"The average Joe Surgeon, civilian or military, has never seen this stuff," Lounsbury said. "Yeah, they've seen guys shot in the chest. But the kind of ferocious blast, burn and penetrating trauma that's part of the modern IED wound is like nothing they've seen, even in a New York emergency room. It's a shocking, heart-stopping, eye-opening kind of thing. And they need to see this on the plane before they get there, because there's a learning curve to this."

The pictures of wounded children include some of a 5-year-old shot in a vehicle trying to run through a checkpoint. Other pictures show wounds riddled with dirt, genitals severed by a roadside bomb, a rib — presumably that of a suicide bomber — driven deep into a soldier's body, and the tail of an unexploded rocket protruding from a soldier's hip.

There are moments that reflect the desperation in the invaded country: an Afghan in the jaw-locked rictus of tetanus after home-treating a foot blown off by a landmine. And moments that reflect the modern American army: a soldier with unexplained pelvic pain that turns out to be a life-threatening ectopic pregnancy.

The book was created to teach techniques that surgeons adopted, abandoning old habits.

For example, they no longer pump saline into a patient with massive trauma to try to get the blood pressure back up to 120. "You do that, you end up with a highly diluted, cold patient with no clotting factors, and the high pressure restarts bleeding," Lounsbury said. Instead, they try to bring it up to just 80 or 90 with red cells and extra platelets, which encourage clotting.

Also, initial surgery even on a severely wounded patient may be brief — just enough to control hemorrhaging and prevent contamination by a torn bowel. Then the patient is returned to intensive care to warm up, raise the blood pressure and restore the electrolyte balance. The next operation is usually just enough to stabilize the patient for transport to a more sophisticated hospital, perhaps in Baghdad or Kabul, in Germany or the United States.

The book describes a surgeon who erred fatally by trying to do too much — a four-hour operation on a soldier who had lost a leg to a roadside bomb. The effort drained the forward hospital's blood bank, and the patient died on the helicopter to the next hospital.

Also, neurosurgeons treating a blast victim now quickly remove a large section of the skull to relieve pressure, even if no shrapnel has penetrated. Such patients are sometimes able to walk and talk after a blast but then collapse and die as their brain swells.

The procedure is described by the surgeon who saved Woodruff's life that way.

Amputations have also changed. Lounsbury's brother lost both legs and an arm in Vietnam, and in those days clean "guillotine" amputations were done as high as possible. Now surgeons try to preserve as much bone and flesh as they can, even if the stump is unsightly. Modern prosthetics are molded to it.

Doctors have also become quicker to diagnose "compartment syndrome" even in patients too sedated to feel pain; swelling in an injured muscle can cut off the blood supply, leading to gangrene and amputation. Surgeons now "fillet" the muscles to relieve the pressure, often even before it builds, since restitching healthy tissue is better than losing a limb.

And when morphine is not enough, nerve blocks — internal drips of local anesthetic, often given by a small pump held by the patient — have become common in pain control.

Ramanathan Raju, chief medical officer for the New York City Health and Hospitals Corporation and a former trauma surgeon, viewed the book and said it would be "extremely useful" to civilian surgeons because of what it teaches about blast injuries and when a surgeon should stop to let a patient recover.

"The army should be very happy about this," Raju said. "In the past, people said, Oh, army surgeons are like butchers, they're not research oriented. This shows how skillful they are."

One of the book's most powerful aspects is its juxtaposition of operating room photographs with those of the war outside the tent. It is filled with random shots — burning vehicles, explosions, a medic carrying a child, another in a Santa Claus hat. It also has portraits of soldiers, often dazed and exhausted; one even has tears on his cheek.

Many are by David Leeson of The Dallas Morning News, who was embedded with the Third Infantry Division during the Iraq invasion and won a Pulitzer Prize for his coverage.

Even more humanizing are photos of recovered patients: an Iraqi whose jaw was destroyed shown with it rebuilt, a soldier who lost half of his skull smiling at a ceremonial dinner with his wife, a soldier whose face was pulverized by a blast looking scarred but handsome a year later.

Military censors suggested numerous changes, including removing photos showing burning vehicles and the faces of any American wounded. They also wanted to excise references to branches of service and how injuries occurred.

For example, according to unclassified e-mail provided by the authors, one suggested removing this description: "A helmeted soldier suffered a forehead injury during the explosion of an improvised explosive device. He was a front seat passenger" in a Humvee. The censor suggested: "A 22-year-old male was hurt in a blast."

Two in the chain of command who raised such objections — one civilian and one officer — said they did so only out of concern for patients' privacy and for security reasons. For example, they said, mentions of wound patterns might tell the enemy that helmets and Humvees were vulnerable.

But the authors argued that it was crucial for surgeons to expect wounds behind armor and absurd to conceal that they occurred.

"The enemy knows that," said Stephen Hetz, a retired colonel and co-author.

They also argued that the book was dedicated to soldiers and marines and that the wounded were proud to be identified as such. All whose faces were fully shown, whether American, Iraqi or Afghan, had given written permission, they said. If it was not obtained, patients' eyes were covered with black bars. The random war photos, they argued, were as much as five years old and some had been in newspapers, so they would give enemies no useful information.

Censors also tried to prevent the book from getting a copyright and the international standard book number letting it be sold commercially, Lounsbury said.

Ultimately, they were overruled.

Kevin Kiley, a retired lieutenant general who was the army's surgeon general when the book was being prepared, said some higher-ups in the military had been worried that the pictures "could be spun politically to show the horrors of war."

"The counter-argument to that, which I concurred with," Kiley said, "was that this is a medical textbook that could save lives."

He said it "absolutely" ought to be available to civilians, particularly to surgeons.

Hetz said that as a West Point graduate and onetime infantry officer — and as a former aide to two surgeons general, to whom he could appeal directly — he always had more faith than Lounsbury that the book would ultimately not be suppressed.

"There was never any doubt in my mind that the army would publish this," he said. "It was just a matter of getting around the nitwits."

The article mentions $71.00 but a google search for the title indicates as much as $100.00

http://www.amazon.com/War-Surgery-Afghanistan-Iraq-2003-2007/dp/0981822800

Another article with pictures ets.

http://www.nytimes.com/2008/08/05/health/05surg.html#

FMF DOC
08-16-2008, 12:20
I found it on Amazon for $100.00 couldn't get on the government website for it, if anyone see's it anywhere else for cheaper please let me know, I'll end up getting it one way or another. Thanks for the info.

RTK
08-16-2008, 18:41
Military Providers can order a copy through the Borden Institute. Credentialed providers, as I understand it, are authorized a copy directly from Borden.

http://www.bordeninstitute.army.mil/published.html

FMF DOC
08-16-2008, 21:21
Thank You RTK

Doc Dutch
08-19-2008, 23:03
One of the authors is coming to interview with me, tomorrow. I will ask him what is up with this.

D-

Doc Dutch
08-20-2008, 22:25
Had a very nice meeting today with one of the authors of this text. He ran everything through the appropriate channels (OPSEC) and the Army's Surgeon General always supported this book getting done. In fact, the military was very supportive of this project and in fact the NY Times article might be considered one opinion of what really happened. It sounds as if he has authored this text for all of us as a medical / surgical moment in time, a snapshot of war not only for these two current campaigns but as a reference for future wars the world over as to what to expect and find and how to do it. It is a detailed text on case-based scenarios.

I feel it will be one of the most important textbooks for trauma and acute care surgeons especially if they enter the US military service or go on humanitarian missions with groups like MSF (Doctors without Borders) in worn-torn countries. Personally, I highly recommend it. It has wonderful details and colored images. It will not disappoint. It is on back order as additional copies are being printed. I will make this text part of the required reading for our Trauma and Acute Surgery Fellowship in Phoenix, AZ.

incidentally, we had a long talk and a detailed conversation about issues facing military medicine in these campaigns. Fascinating and proud to have spent the last 45 minutes talking to a this very humble surgeon.


Dutch

MILON
08-21-2008, 12:53
I have seen mention of this book being very helpful for providers, but would it be a beneficial resource for a medical section as a whole? Does the text contain information on immediate care within a 68W scope or is it surgery specific. If it would be a good thing to get can we order it or can only providers get a copy? We do not currently have a provider. Thanks.

Odd Job
08-22-2008, 13:31
Thanks Snaquebite and Doc Dutch.

JJ_BPK
08-22-2008, 15:01
Snaquebite, et all,

I've passed this on to the three ER Doc's I know. I'll pass any feedback I hear..

Doc Dutch
08-24-2008, 12:54
Matthew,

I am reading it. So, here is my take.

The forward has some details about transport into and out of theater which is general information. The deied from injuries section is also worth reading. There are some points for the EMT, medic, corpsmen level, etc, however, in all fairness this case base scenario written text is primarily for the surgeons, critical care physicians and possibly even CRNA's or anesthetisologists. Nursing? Probably not, but then again it does give wonderful overviews and could even potentially help nursing understand the ebb and flow in the pre-op, OR, and post-op areas as to what is thought and what is done and why it is done that way.

Also, I think that if you feel that you are destined to go "down range" or you are joining MSF Doctors without Borders) and will be in a war zone encountering these types of cases and injuries on a large scale or small scale, a book companion like this read in your down time is a must. I have to tell you, I am reading it now, and will take it with me to Landstuhl and eventually to either campaign in the Middle-East.

As for ordering, you can do it on-line but it will run you 75 to 80 dollars and takes several weeks to be delivered as the first printing went so fast, so be patient.

I think the pictures speak volumes and the before and after images show you two things. The first is how hard these soldiers have it and the injuries they are sustaining. Like many wars it is only gruesome if you are not familiar with human anatomy and trauma care. The second is the great care that these men receive and how their young bodies heal with the care they get in the field and at home. It is remarkable. I am not trying to sell this book nor do I have a financial interest in it, but if you are serious about educating yourself medically speaking before you go, again, I might consider it.

Dutch Matthews

Doc Dutch
08-24-2008, 13:05
Matthew,

I just checked the Trauma.org webserver and this is what I pulled off from one of the e-mails (I excluded the sender's name and e-mail address),

"*War Surgery in Afghanistan and Iraq* which I ("back
ordered" when it was first available) arrived today from the Govt Printing Office".

So, Matthew, try going to the Gov't Printing Office and see what they are saying about cost and the time for delivery.

I hope these posts helped.

Dutch Matthews

MILON
08-25-2008, 13:03
Doc Dutch,

Your insight was very helpful and much appreciated. On a personal level, I will likely purchase this book in the near future. Not sure about medical school, but a career in medicine is where I am heading. I plan to present the idea to my medical section to see if they are interested as well. We just returned from a deployment and are a young section with much to learn. I'll look into the Government Printing Office.

Thanks again for your help.

Matt

LavaDoc
09-26-2008, 23:48
Thank you for the info on the book. Is there a National Stock Number for it? I would like to order it through our supply chain, but the computer has a bad habit of timing out when I try to execute a search.

DrJay
12-24-2008, 19:07
Huge +1 on this book. I was fortunate to get a heads-up on its release and was lucky enough to get a copy from the Government Printing Office (GPO) for around $75. A lot of the info had trickled down to me via other sites like lightfighter.com; stuff like the indispensability of tourniquets in the hands of individual troops (and the training to use them), limiting the volume of fluid resuscitation to reduce hypothermia/anemia/cardiac arrhythmia; stabilizing surgery followed by temporary closure with evac out of theater, etc.

Very graphic photographs, but surgery is a graphic profession.

I'm not a former 18D (18BangBang here)so can't really comment on how it would apply to the SOFMed training, but the book would be useful to a medical section if for no other reason than showing the new troops what to expect in the sandbox.

As an urgent care doc the goriest stuff I see are huge MRSA abcesses and some truly bizarre lacerations.

Dr J

IV Slinger
01-01-2009, 11:07
For those in the Healthcare field, you can order a free copy from the Borden Institute.

http://www.bordeninstitute.army.mil/order.cfm

I have some of the other books published by the Border Institute, and they are full of quality information.

_____________________________

Totally just saw that somebody already posted this link above.

OK, let me just say than that I am an E-4, and I had no problems receiving "War Surgery". If your reasons are valid, I think they will send the book to you as long as you are in the medical field.

Eagle5US
01-01-2009, 12:44
For those in the Healthcare field, you can order a free copy from the Borden Institute.

http://www.bordeninstitute.army.mil/order.cfm

I have some of the other books published by the Border Institute, and they are full of quality information.

_____________________________

Totally just saw that somebody already posted this link above.

OK, let me just say than that I am an E-4, and I had no problems receiving "War Surgery". If your reasons are valid, I think they will send the book to you as long as you are in the medical field.

You need to follow the instructions sent to you in your registration message before you post on this website again.

Your post is misleading in that you state "for those in the healthcare field", This implies anyone; civilian, military, students, etc...
What "you think" really is not important when you post something as fact.

Your situational awareness and ability to follow simple instructions is lacking.

Eagle

MILON
01-01-2009, 13:14
I just looked into the link given by IV Slinger and the details on who can order were not given. The details are below.

Active duty military medical personnel may obtain one (1) complimentary book from the Textbooks of Military Medicine series by completing the online order form. Please supply a duty station address including a street address or building number (books cannot be delivered to PO boxes, except for APO addresses; for APO addresses, be sure to include the CMR/PSC and box number).

Civilians can purchase Textbooks of Military Medicine volumes through the Government Printing Office (GPO) Web site at http://bookstore.gpo.gov or via telephone at 202-512-1800. For orders from outside the United States, please add 25% to the price of the book.

Found at http://www.bordeninstitute.army.mil/ordering.html

I tried ordering a copy for our medical section (national guard, not active) before I knew the details. I'll post again if I am able to aquire one.

IV Slinger
01-02-2009, 09:25
I just looked into the link given by IV Slinger and the details on who can order were not given. The details are below.

Active duty military medical personnel may obtain one (1) complimentary book from the Textbooks of Military Medicine series by completing the online order form. Please supply a duty station address including a street address or building number (books cannot be delivered to PO boxes, except for APO addresses; for APO addresses, be sure to include the CMR/PSC and box number).

Civilians can purchase Textbooks of Military Medicine volumes through the Government Printing Office (GPO) Web site at http://bookstore.gpo.gov or via telephone at 202-512-1800. For orders from outside the United States, please add 25% to the price of the book.

Found at http://www.bordeninstitute.army.mil/ordering.html

I tried ordering a copy for our medical section (national guard, not active) before I knew the details. I'll post again if I am able to aquire one.

You should be fine. I'm an E-4 in the Reserves, and my unit isn't a medical one (Although I am a medic), and I received this and several other books from the Borden Institute.

I think I received this one around mid-October and I have yet to receive any sort of bill or request for payment. I expect you won't have any problems either.

Surgicalcric
01-02-2009, 10:09
IV Slinger:

You were given specific instruction by Eagle5US above and it seems you have chosen to blow him off.

Read/re-read the email you received after registering here and follow the instructions contained therein. DO NOT post again until it has been completed.

You will not be told again.

Questions?

Crip

olhamada
01-27-2009, 20:21
I just got this book. It is excellent and very well done. Very humbling to see the price some paid. Thank you for the heads up.

ReconRover
03-29-2009, 14:02
Got the book about 4 months ago. Well worth it. Very good info on traumatic wounds, and what can be done to stabilize, etc. I show it to clients that don't like to wear their body armor, or want to go shopping in the bazaar. Gives a good kick in the pants.

I always pass the book around after a BLS refersher with the boys, kind of brings it home for them.

P

fritzscorner
03-30-2009, 22:49
For those that ordered this book or any other from borden istitute as the 1 free complimentary book how long did it take before you recieved it in the mail? I ordered this same book in early feb and have not recieved it yet.

MILON
03-31-2009, 11:21
fritzscorner,

I ordered it from borden and it took a while. I dont recall how long exactly, but it was long enough for me to forget I ordered it. Be patient, I imagine it will come. If you forget you ordered it, its a great surprise! :D

MILON

fritzscorner
04-01-2009, 17:33
Was just asking because Ill be down range in theater soon and would like to have it before I ship out.

NeverSayDie
12-22-2011, 16:49
I believe I may have recently come across a copy of this in my college library in the government records section. I gave it a quick flip through but unfortunately was hard pressed meeting a deadline on an essay and did'nt have the time to give it the proper attention. After the holiday break is over I can run it through the scanner, convert it to a PDF, and upload it here to save everyone some of the time and money involved with ordering it.


NSD,

EMT-B Student, 68W DEP, Ranger Hopefull (aka. as cherry as they come)

Surgicalcric
12-22-2011, 17:27
...After the holiday break is over I can run it through the scanner, convert it to a PDF, and upload it here to save everyone some of the time and money involved with ordering it...

It is available from the Borden Institute free of charge. No need to upload it here.

NSD: You would do well to spend time here reading and much less time posting. If I were you I would start with searching for "Situational Awareness" and follow that up with "A Message For Garcia."

You have plenty to learn...

Welcome to PS.com.

Crip