BEIRUT EXPERIENCE

LtCol David Kissinger,M.D.,Presentation Given at Folk Polk to Special OPS Wing, Feb 1996.




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AEROMEDICAL EVACUATION 









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REGIONAL MEDICAL ASSETS 














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FOG of WAR 




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CHRONOLOGY, SUNDAY MORNING

Beirut Marine Barracks Bombing




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CASE PRESENTATION

  • "Semper Fi Marine"
    • 23 year old male
    • severe blast injury
    • multiple fractures (right UE, bilateral LE)
      compartment syndrome
    • depressed skull fracture
    • bilateral TM rupture
    • marked facial swelling 



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TRIAGE

  • Situationally dependent
    • 5 operating rooms
    • 5 operating room teams
    • 2 general surgeons
    • 2 orthopedic surgeons
    • depressed skull fracture
  • Could engage and treat 



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SURGICAL SUMMARY

  • 25 major cases in first 24 hours
  • 16 "take back" operations during following 24 hours
  • No deaths
  • No permanent disabilities
  • No extremities lost 



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GENERAL SURGEONS

  • Coordinated all 25 patients and made treatment priority decisions
  • Operating room
    • rotated 5 rooms
    • "tag team" with general and orthopedic surgeons 



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ORTHOPEDIC SURGEONS

  • Triaged with general surgeons
  • Rotated as general surgeons did, in and out of operating rooms and preop area 



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OPERATING ROOM ROTATION 













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PATIENT CORE

  • Every patient had his own physician
  • MD responsible for:
    • lab
    • X ray
    • minor wound care
    • "his" patient 



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PULMONARY BLAST INJURIES

  • "Semper Fi marine"
    • ventilator dependent 5 days
  • Four others required >24h ventilator support 



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POINTS to CONSIDER

  • Communication with next echelon of care
    • diagnosis
    • therapy
    • initial plan for care
  • Resource allocation
    • when and how to use resources
    • limiting factors...more physicians than patients
  • When to delay and when to treat definitively
  • Every provider neeeds to know perioperative care
    • "Semper Fi marine" crashed between cas 16 and 17!!!! 



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CHRONOLOGY

  • Beirut explosion (Oct 83)
  • Investigations continued (Dec 83)
  • FAST concept sold to USAFE (Aug 84)
  • Lessons not applied to Desert Storm (Feb 91)
  • 59th MDW fields POC teams (Jun 94)
  • Improvements continue to date 



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LESSONS LEARNED