Save Lives, Save Limbs

Save Lives Save Limbs cover“Save Lives, Save Limbs. Life support to victims of mines, wars, and accident” is indispensible for anyone involved in mine victims assistance, relief work in civil disasters, or even first aid in emergencies and accidents.

Yet there is more to Save Lives, Save Limbs  than life-saving first aid and surgery – it is also a guide to self-empowerment for rural communities stalked by this deadly epidemic. Step by step it shows how villagers in the South can build support networks to handle victims of mines and other disasters – taking into account the differences in infrastructure, terrain and clime, in healthcare and socioeconomic systems.

The book is available in English, Farsi, Pashto, Kurd, Burmese, Shan, Khmer, Vietnamese, Spanish, Nepali and Arabic editions.

When a land mine explodes every 10 minutes somewhere in the world – taking or maiming another life – it makes the appearance of Save Lives, Save Limbs all the more timely. This book is indispensible for anyone involved in mine victims assistance, relief work in civil disasters, or even first aid in emergencies and accidents.

Yet there is more to Save Lives, Save Limbs than life-saving first aid and surgery – it is also a guide to self-empowerment for rural communities stalked by this deadly epidemic. Step by step it shows how villagers in the South can build support networks to handle victims of mines and other disasters – taking into account the differences in infrastructure, terrain and clime, in healthcare and socioeconomic systems.

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Why is Save Lives, Save Limbs different?

The handbook’s exceptional qualities are due to its radical departure from common Western medical orthodoxies:

* It is not true that only qualified staff can give qualified life support. Victims start dying at the time of injury. Immediate first aid by lay first responders can save lives.

* It is not true that non-graduate rural folk are too “ignorant” to staff and manage health networks-traning programs by themselves. With training at “village universities”, they are able to set up sustainable chains of survival for trauma victims of mines and other medical emergencies.

* It is not true that indigenous resources and knowledge, locally adapted equipment and training aids are inferior to Western standards and imports. On the contrary – not only are they better – there is often no other way to build sustainable capacities.

Save Lives, Save Limbs. is the result of 10 years’ teamwork experience of the authors and local health workers in Afghanistan, Burma, Cambodia, Kurdistan and Angola who have treated thousands of trauma victims and set up numerous “chains of survival” under all kinds of adverse, even harrowing, conditions.

This guidebook is useful for mine medics and first aid trainees; teachers training health workers, organizers of medical/health services or mine-assistance programs; and A&E hospital staff.

The authors are presently attached to the University Hospital of Tromsoe, Norway. Also, they are engaged in medical European NGOs supporting the casualties of regional wars and conflicts in Third World countries; and have 20 years’ experience in the field as organizers, consultants, surgeons and emergency medical doctors.

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What are other saying about this life support manual?

“Everyone whose work involves contact with mine-affected communities should consider this book a vital resource.” – Rae McGrath, Nobel Prize laureate, 1997

“Had I had this book in my work as a health worker and trainer of health workers in the mountains of Mexico, many persons who died from stabbings, bullet wounds and traumatic accidents in remote villages might still be alive today. A splendid and important book.” – David Werner, Author of Where There is No Doctor, Helping Health Workers Learn, and Nothing About Us Without Us.

“Talk of the empowerment of impoverished and repressed communities is all too often empty rhetoric. This book is a concrete example of what can be done, practically and pragmatically, to help save lives and limbs. In the didactic traditions of Where There is No Doctor and community solidarity work, this book is an excellent addition in helping to fill an important gap.” – Chris Paul Giannou MD, Head of Unit of Surgery and Hospital Assistance, ICRC. (The views expressed are those of CPG and do not necessarily represent those of the ICRC.)

“This book is the outcome of a long and intensive experience in minefields and war zones in the South where there are no helicopters, no ambulances, and where hospitals are far away. By answering the question of whom to train, where and how to save lives and limbs, this manual is an invaluable resource for all workers in the field.” – Claude Romer MD and Pierre Bwale MD, PVI, WHO Geneva

“Everyone who faces injury is frightened – the victim, their family or friends, and even the medic. This book has been written by people like you. They have seen what you see. They know that to meet and overcome the fear needs knowledge, understanding and practice. Only in this way can you begin the journey to save your victim’s limbs and lives. The first step on this path is to open the book – so do it now.” – Colin Robertson MD, PhD, Consultant in Accident and Emergency Medicine, Royal Infirmary of Edinburgh

“This excellent handbook for medics will enable the world to give appropriate early care to thousands of trauma victims. It will empower communities to handle devastating injuries by encouraging them to develop local care structures and teach life support. This excellent text tells individuals and communities in detail how to give emergency care and set up training programs. Good first aid requires education and organization. Without either, precious time is lost in victim care. This manual shows how to do it.” – James C. Cobey, MD, MPH, Physicians for Human Rights Health Volunteers Overseas, Washington, DC

“This concise, superbly produced, and richly illustrated volume is an eye opener. I strongly recommend this book as compulsory reading to all health care professionals…and to all doctors, students and paramedical staff of Third World countries – since trauma and its care involves all of them. The authors emphasise a holistic approach to the trauma victim. They tell us what can be achieved under the most trying conditions. Their suggestions are pragmatic, and their recommendations achievable; that is reason enough to read this book.” – Lt Col K M Rai, SM, Department of General and Vascular Surgery, Army Hospital (Research & Referral), Delhi, India

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Contents of Save Lives, Save Limbs

Foreward by Rae McGrath

Contributors
About the Authors, our methods, and results
How to use the book

SECTION 1: The body’s response to injury
Oxygen is life – oxygen starvation is death
Fragmentation mines
How Fragmentation mines injure
Life support: airway and breathing, blood circulation
Ban the tourniquet!
Prevent infection – support the body’s defences
Sum up: early life support is good life support

SECTION 2: Simple life support
Prepare yourself! Work together!
Danger! The victim is inside a minefield
How to examine a victim
Open the airway
Support the breathing
Stop the bleeding
Intravenous cannulation
Replacing blood loss: volume treatment
Warm the victim
Victim’s position
Drugs for pain
Comfort & encouragement
Prevent infection. Antibiotics
Victims need food
Not awake and no breathing
Mass casualties
The injured child
Burn victims
Problems caused by diseases
Transport to hospital
Medical documentation
Take care of yourself and your helpers

SECTION 3: Advanced life support
Endotracheal intubation
Airway cut-down
How to place chest tube drain
Damage control laparatomy
Venous cut-down
Limb fasciotomy – why and when? How?
Ketamine anesthesia
Disinfection

SECTION 4: Case stories from real life
He drowned in the river
Grandma lost her foot
Stopping limb bleeding
Head injury in mine clearer
Abdominal bleeding
Severe injuries, no hospital
Improvised chest tube
Angola: bus hits an anti-tank mine

SECTION 5: The chain of survival
Osman, a life saver in Kurdistan
What is the chain of survival?
Mapping the mine injuries
Setting up a local plan
Why a Village University?
How much does it cost?
Funding the chain of survival

SECTION 6: The Village University
How to select students
Setting up the University
Advise to the teacher
1st course: simple life support
2nd/3rd course: Advanced life support
Anesthesia for animals
Animal case stories
Drinks from local foodstuffs
Medical kits
The medic as teacher
Village course for first helpers
Is the treatment good enough?
Certification

Some practical advice:
Drugs & doses
IV fluids for volume treatment
Malnutrition & feeding
Measuring blood pressure
Sutures & surgical knots
Diameter of cannulas, catheters & tubes
If you don’t have what you need – use what you have
Severity score for child victims
Analyse your results
Applying for funding
Teaching aids
Books for further studies
Useful contacts

Drawings of the body
Glossary
Index
Injury and anesthesia charts for tear out
Pocket folder

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