Awareness of damage control surgery and resuscitation practice: Rational emergency surgical trends in mass trauma events in Syria

BACKGROUND: Mass trauma is an event in which the number of patients temporarily exceeds the capacity of medical personnel to provide optimal care. Looking at the global terrorism index, Syria is one of the most terrorism-affected countries in the Middle East, and the threat of terrorist attacks that can cause mass trauma persists. When it comes to dealing with mass trauma, the damage control approach has come to the forefront in recent years. In our study, we aimed to assess the awareness and training effectiveness of emergency physicians and surgeons on damage control surgery and resuscitation in Northwest Syria, where mass trauma due to terrorist attacks and social events is common.
METHODS: A trauma team from Çobanbey Hospital in Northwest Syria conducted training on damage control and resuscitation. Syrian physicians who participated in this training were administered a damage control and resuscitation questionnaire before and after the training.
RESULTS: A total of 43 subjects were enrolled in the study, and their mean age was 44.04±9.01 years. The majority of the physicians who participated in the training were from Elbab (23.3%), Afrin (23.3%), and Çobanbey (20.9%). The average work experience of the physicians was 14 years and the average number of non-elective surgeries performed in the last year was 47.5. While the average total score (pre-test) before the training was 67, the average total score (post-test) after the training increased to 72, and this difference was statistically significant (p=0.008). While the pre-test and post-test scores of those who were trained and had practiced placing intrathoracic clamp-wound clamp and trauma laparotomy were significantly higher than those who were not trained and had not used them (p<0.05), the difference between the pre-test and post-test scores of those who were not trained and had not used them was statistically significant (p<0.05).
CONCLUSION: It is well known that there have been internal unrest and terrorist attacks in Northwest Syria for more than 10 years. It is important for physicians in this region to know the damage control strategies. In this regard, we have found that awareness among physicians has increased as a result of the training we have provided on damage control.

Hasar kontrol cerrahisi ve resüsistasyonu uygulama farkýndalýklarý: Suriye’de kitlesel travmalý olgularda akýlcý acil cerrahi uygulama eðilimleri

AMAÇ: Kitlesel travma olayý, hasta sayýsýnýn saðlýk personelinin en uygun bakýmý saðlama kapasitesini geçici olarak aþtýðý bir olaydýr. Global terörizm indeksine bakýldýðýnda Ortadoðu’da terörizmden en çok etkilenen ülkelerin baþýnda Suriye gelmektedir ve kitlesel travmalara neden olabilecek terör riski devam etmektedir. Kitlesel travmaya yaklaþým denilince hasar kontrol yaklaþýmý son yýllarda öne çýkmaktadýr. Biz de çalýþmamýzda terör saldýrýlarý ve toplumsal olaylar nedeniyle kitlesel travmalarýn çok görüldüðü Suriye’nin kuzeybatýsýnda, acil ve cerrahi branþ hekimlerinin hasar kontrol cerrahisi ve resüsitasyonu konularýnda farkýndalýðýný ve eðitim etkinliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Suriye’nin kuzeybatýsýndaki Çobanbey Hastanesi’nde bir travma ekibi tarafýndan “Hasar kontrol cerrahisi ve resüsitasyonu” konularýnda eðitim verildi. Bu eðitime katýlan Suriyeli hekimlere eðitim öncesi ve sonrasý hasar kontrol cerrahisi ve resüsitasyonu açýsýndan farkýndalýk anketi yapýldý.
BULGULAR: Çalýþmaya toplam 43 kiþi dahil edildi ve yaþ ortalamalarý 44.04±9.01 yýldý. Eðitime katýlan hekimlerin çoðunluðu Elbab (%23.3), Afrin (%23.3) ve Çobanbey’den (%20.9) gelmiþti. Hekimlerin ortalama mesleki tecrübesi 14 yýldý ve son bir yýlda elektif olmayan ameliyat sayýsý median 47.5’ti. Eðitim öncesi öntest toplam puan ortalamasý 67 iken, eðitim sonrasý sontest toplam puan ortalamasý 72’ye yükselmiþti ve bu farklýlýk anlam-lýydý (p=0.008). Ýntratorasik klemp yara kelepçesi yerleþtirme ve travma laporotomisi eðitimi alan ve uygulamayý yapmýþ olanlarýn ön test ve son test puanlarý eðitimi almamýþ ve uygulamamýþ olanlara göre anlamlý olarak fazla iken (p<0.05), eðitimi almayan ve uygulamayanlarýn ön test son test puanlarý arasýndaki farklýlýk anlamlýydý (p<0.05).
TARTIÞMA: Suriye’nin kuzeybatýsýnda 10 yýldan uzun süredir iç karýþýklýk ve terör eylemlerinin mevcut olduðu bilinmektedir. Bu bölgedeki hekimler için hasar kontrol stratejilerinin bilinmesi önem arz etmektedir. Bu baðlamda verdiðimiz hasar kontrol cerrahisi ve resüsitasyonu eðitimi ile hekim-lerde farkýndalýðýn arttýðý görülmüþtür. Ýnsani yardým amaçlý açýlan hastanelerde bu tarz ve benzeri ileri düzey eðitimlerin faydalý ve hayat kurtarýcý olacaðýný düþünmekteyiz.