Extent of pre-hospital medical care to civilians with abdominal gunshot wounds

Introduction. Abdominal gunshot wounds account for 4.7–16.2% of injuries among their total number. Such wounds carry a high risk of fatal outcomes (depending on the nature of the wound, whether isolated or combined), as well as a large number of complications. In this regard, provision of proper and timely pre-hospital medical care is a highly important task.

Objective. To assess the extent and quality of pre-hospital medical care provided to civilians with gunshot abdominal wounds.

Materials and methods. The quality of emergency medical care was assessed based on a retrospective analysis of source documents: run sheets (Form 114/u), and records of 60 civilian patients (47 (78.3%) men and 13 (21.7%) women; average age 35 ± 5 years) in the special military operation (SMO) war zones. All injured were divided into two groups: (1) 46 (76.7%) wounded patients having received medical care from emergency medical teams (EMT) staffed with physicians and (2) 14 (23.3%) wounded patients having received medical care from EMTs staffed with paramedics. The EMT response time and extent of medical aid were assessed. The severity of the patient’s state was assessed using the Battlefield Surgery Emergency Scale.

Results. It was found that the ambulance response time varied 5–30 min and averaged 24 ± 4 min for physician EMTs and 21 ± 6 min for paramedic EMTs, which can generally be described as normal. In total, 57 (85%) wounded had projectile wounds, with gunshot wounds being recorded in 3 (5%) cases. Multiple wounds were predominant in 52 (86.7%) cases, whereas single wounds were noted in 8 (13.3%) cases. A non-severe, severe, extremely severe, and critical state was recorded in 38 (63.3), 9 (15%), 12 (15%), and 1 (1.7%) patients. In the vast majority of cases (54 (90%)), the provided care was timely, proper, and to the full extent. At the same time, in 6 (10%) cases, the extent of provided emergency medical care could be considered insufficient: in 2 (3.3%) cases with physician EMTs and in 4 (6.7%) with paramedic EMTs. The errors were related to underestimating the severity of the patient’ state, which resulted in inadequate anesthesia and infusion therapy, i.e., the absence of antishock actions.

Conclusion. Pre-hospital medical care to injured civilians with abdominal gunshot wounds is provided by physician and paramedic EMTs. The extent of medical aid includes wound treatment and aseptic dressing application, adequate anesthesia, and antishock actions. A lower error rate in the provision of emergency medical care by physician EMTs in comparison with paramedic EMTs was observed. Centralized measures should be implemented to improve both the theoretical knowledge and practical skills of EMTs in providing pre-hospital emergency medical care for abdominal gunshot wounds. To that end, it is necessary to involve surgeons and disaster medicine specialists in training emergency medical personnel.

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