War surgery – Field manual. 2nd revised edition

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This book takes a unique approach to the subject of trauma and war surgery. This ground-breaking work sets a standard reference for care under difficult conditions, with the lack of medical facilities and proper staff. It promotes a concept of forward life support and surgery, which draws on the resources and knowledge of the local community, which improvises with local equipment and materials, and also includes a complete guide to post-operative, high-energy nutrition based on local foodstuffs and food-processing traditions.

The second revised edition contains updates on the injuries caused by modern weaponry, on post-injury physiology, and on damage control surgery. It can be downloaded for free or read online below.


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Publisher: TWN
ISBN: 978-983-2729-21-1
Year: 2011   No. of pages: 880
21 cm x 27 cm


MargBok – margbok@gmail.com
Strandveien 95
9006 Tromso

Price: NOK 800

Third World Network – twnet@po.jaring.my
131 Jalan Macalister
10400 Penang

Price: US$ 40 (Third World countries) or US$ 140 (other countries)

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Do not let the size of this book intimidate you. Let it be your companion in the war zone. It has to be comprehensive, since it might be the only book you can afford.
We also know many of you have only very basic medical education. We therefore spend time explaining things.

The book is in three parts
The first part of the book is about Primary Trauma Care and it is marked by the black strip on the top of the pages. Most fatalities occur outside the reach of hospital surgons. This section explains how deaths can be avoided by life support given by trained non-graduate health workers. This is the section that everyone interested in helping survivors have to study, whether you are a graduate or non-graduate.

The next part of the book concentrates on surgical and anesthetic techniques.
Those who are not keen to work inside the operating theatre can be excused from reading it. It is marked with the black strip at the bottom of the page. We know from experience that many doctors in the third world do not have the luxury of a lengthy surgical and anaesthetic training, and indeed many surgical training programmes in the high-income countries are not suited to the situation in poverty stricken third world countries attacked by sophisticated weapons.

We write surgical techniques with them in mind. We do not think the concept of “Read One – Do One” is a good way to practise surgery, but we know there will be some of you who have no choice. For some of the authors at least that was how we started. Study the techniques well, email us with your queries and suggestions.

The last part is unmarked, and is scattered throughout the book. It is about logistics, teaching, documentation, audit and research. In the war zones of the Third World, thousands are killed and wounded. Their medical attendants have continually developed better and more efficient methods of dealing with the wounded.

Yet very rarely is their voice heard in established medical and surgical literature. Eg. you can hardly find one word in the “classic” textbooks on post-injury malaria Falciparum, a threat to a population of 400 million people around the globe.

Therefore we have paid much attention to documentation, audit, and research, and communication. It is the duty of all to report and share experience and new techniques, to encourage each other, to constructively critique each other so that we are no longer alone. This is the culture of enabling survival – the forum for survival.

There is one more book to study. Surgeons often consider the job done when the patient is carried out of the operating theatre – and definitely so when he is discharged from the hospital. Thirty years of surgery in the war zones in the South has taught us that they are wrong: a lot of survivors in poor communities suffer from chronic pain and a sense of worthlessness, so much that they cannot carrty an artifical limb, and much less provide for their family. In fact, poverty is as much a trauma as the injury itself. So, the end-point where you should measure success or failure of treatment is not the operating theatre – but the village and the urban slum, months and years after injury. Lizz Hobbs’ beautiful rehabilitation manual, Life After Injury, helps you find ways to cope in the long term, see reference list, see p. 849. There is a pocket folder at the back cover. It helps you keep the head cool in difficult situations, especially when treating child victims.



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Hans Husum
is a general surgeon with thirty years of experience with popular movements in the war zones and mine fields of the Middle East, Iraq, Afghanistan, and Southeast Asia. He is a founding member of Trauma Care Foundation, an institution developing teaching aids in trauma care for low-resource communities. Hans Husum heads Tromsoe Mine Victim Resource Center, an action-research center at the University Hospital of North Norway and has published extensively on trauma systems in war with colleagues in the South.

Erik Fosse
is specialist in general and cardiothoracic surgery. He is professor of surgery at the University of Oslo and director of the Interventional Centre, which is a research and development department at Oslo University Hospital. Erik Fosse is the director of NORWAC, a humanitarian medical NGO working mainly in The Middle East and the Balkans. He worked as a surgeon with the Afghan resistance
in 1986 and in Albania during the Kosovo war in 1999. Since 1979 he has worked during several wars in Lebanon and Palestine with Palestinian organizations, including the war in Gaza in January 2009. Erik Fosse is consultant in war surgery with the Norwegian Military Medical Services.

Swee Chai Ang
is consultant trauma and orthopaedic surgeon at St Bartholomew and the Royal London Hospital, England. She and her team treated many of the major casualties of the 2005 7/7 bombings in London. Since 1982, she has worked on multiple occasions as orthopaedic surgeon to the Palestinians in the Lebanon and Gaza, with the
Palestine Red Crescent Society, the United Nations and WHO. She is co-founder and patron of the British Charity, Medical Aid for Palestinians. She has also been on several relief missions to the Pakistan Kashmir earthquake. Her publications include papers on acute care of the war wounded. She penned her survivor eyewitness account of the 1982 Beirut Sabra Shatilla massacre in her book “From Beirut to Jerusalem”. The late Yasser Arafat awarded her the Star of Palestine for her work with his people.


List of contributors

Saeed Stroemmen-Bakhtiar, PhD
Associate Professor, Centre for Enterprise Architecture and Information Systems (SVAIS), University of Nordland, Norway.
Chapter 5

Yang Van Heng, MPH
Director, Trauma Care Foundation Cambodia.
Chapter 1 and 2

Mohamad I. Hijazi MPH
Director, Rassoul Alazam Hospital, Lebanon.
Chapter 1

Bjoern Karlsson, Orthopedic Engineer
Tromsoe Mine Victim Resource Center, University Hospital North Norway.
Chapter 13 and 17

Johan Pillgram-Larsen MD
Senior Consultant, Department of Cardio-Thoracic Surgery, Ullevaal University Hospital, Norway. Chief Consultant Surgeon, Norwegian Armed Forces Medical Services.
Chapter 8

Ole Kristian Losvik MD
Director of Research, Tromsoe Mine Victim Resource Center, University Hospital North Norway.
Chapter 4 and 6

Mudhafar Kareem Murad MD
Director, Trauma Care Foundation Iraq.
Chapter 1 and 2

Assaddullah Reha MD, PhD
Director, Mobile Emergency Medical Center, Afghanistan.
Chapter 1 and 3

Mohamad H. Sayeed MD
Consultant, Department of Surgery, Rassoul Alazam Hospital, Lebanon. Islamic Health Society, Directorate of Civil Defense.
Chapter 1 and 8

Nenad Tajsic MD, PhD
Senior Consultant, Department of Orthopedic and Plastic Surgery, University Hospital North Norway.
Chapter 13

Knut Wester MD, PhD
Senior Consultant, Department of Neurosurgery, Haukeland University Hospital, Norway. Professor, Faculty of Medicine, University of Bergen.
Chapter 8

Reiner Winkel MD
Chief, Department of Hand and Reconstructive Surgery, BGU Trauma Center, Frankfurt am Main, Germany
Chapter 13

Chapter 7 is based on the manual Save Lives, Save Limbs, Third World Network, Penang, 2000, by Hans Husum, professor Mads Gilbert, Department of Emergency Medicine, University Hospital North Norway, and professor Torben Wisborg, Department of Acute Care, Hammerfest Hospital, Norway. The authors of War Surgery are responsible for the revision of the original text.

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How to use the book

Foreword to the First Edition

Foreword to the Second Edition

Authors and contributors

Section 1: Trauma systems in war

1.      The chain of survival

2.      Trauma care training

3.      Material input

4.      Trauma severity scoring and quality control

Section 2: Trauma care in war

5.      The weapon

6.      The injury

7.      Trauma life support in war

8.      Life-saving surgery

9.      Triage – sorting casualties

Section 3: Basics of war surgery

10.  Surgical technique

11.  Fasciotomy, debridement and drainage

12.  Injuries to arteries and veins

13.  Fractures and mangled limbs

14.  Joint injuries

15.  Tendon injuries

16.  Nerve injuries

17.  Amputations

18.  Wound closure

19.  Injuries to children and old people

20.  Emergency blood transfusion

21.  Hypothermia and hyperthermia

22.  Diseases interfering with surgery

Section 4: War surgery – specific injuries

23.  Injury to the head and neck

24.  Injury to the spine

25.  Injury to the face

26.  Injury to the eye

27.  Injury to the chest

28.  Abdominal injuries in general

29.  Injury to the intestine

30.  Injury to the stomach and duodenum

31.  Injury to the liver and biliary tract

32.  Injury to the spleen

33.  Injury to the pancreas

34.  Injury to the kidneys

35.  Injury to the urinary bladder and urethra

36.  Injury to the male organs

37.  Injury to the female organs

38.  Complications of abdominal surgery

39.  Pelvic injury

40.  Upper limb injury

41.  Lower limb injury

42.  Burns

Section 5: Treatment after surgery

43.  Post-operative care and complications

44.  Microbiology and infections

45.  Nutrition after injury and surgery

Section 6: Anesthesia

46.  Wartime anesthesia

47.  Ketamine anesthesia

48.  Local anesthesia

49.  Spinal anesthesia





Pocket folder

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Hans Husum has, once again, produced a book of outstanding value for those surgeons who venture “in harm’s way”. This is a book which not only describes the special requirements for war surgery in all specialties but it also describes in detail the scientific basis for this clinical practice. Future war surgeons can be grateful that this excellent work exists and the gratitude will, I am sure, be shared by their patients.

[/et_pb_testimonial][et_pb_testimonial admin_label=”Naser R. Abu Shabaan” author=”Naser R. Abu Shabaan” job_title=”Consultant General Surgery, Director of Higher Surgical Training” company_name=”Gaza, Palestine” url_new_window=”off” quote_icon=”on” use_background_color=”on” background_color=”#f5f5f5″ background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid”]

The new additions to the second edition of “War Surgery” are truly significant and keep pace with the vast development of destructive weapons used in recent wars. The action and effects of modern weapons are explained in a clear and scientific way. I highly recommend the book not only for surgeons and care providers in war, but for all graduates in training in Third World countries.

[/et_pb_testimonial][et_pb_testimonial admin_label=”Charles Mock” author=”Charles Mock” job_title=”MD PhD FACS, Professor of Surgery, Professor of Epidemiology, Adjunct Professor of Global Health” company_name=”University of Washington, Seattle, WA, USA” url_new_window=”off” quote_icon=”on” use_background_color=”on” background_color=”#f5f5f5″ background_layout=”light” text_orientation=”left” use_border_color=”off” border_color=”#ffffff” border_style=”solid”]

As someone who has practiced trauma surgery in low-resource settings in the South, I greatly appreciate the approach taken by “War Surgery, Field Manual”. It is scientifically rigorous, yet practical and readable.  It gives advice and guidance on how to care for individual patients under difficult circumstances and with limited resources.  At the same time, it gives overarching information on how to better organize, plan for, monitor, and evaluate the entire system available for providing care for the injured.  If widely utilized, this book will save the lives of many victims of violence and war globally.


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