Savaş ve Afetlerde Yanıklar
Dr. Elif Asfuroğlu1
Dr. Ebral Yiğit2
1İskenderun Devlet Hastanesi Yanık Ünitesi, Hatay, Türkiye
2Gazi Yaşargil Eğitim ve Araştırma Hastanesi Yanık Merkezi, Diyarbakır, Türkiye
ÖZET
İnsanlık tarihi boyunca var olan savaşlar 5000 yılı aşkın süredir yaralanmalara sebep olmuştur. Barutun bulunması ve ileri teknolojiye sahip silahların geliştirilmesi ile beraber savaşa bağlı yanık yaralanmalarının insidansı artmış, koruyucu önlemlerin ise etkinliği azalmıştır. Savaş hallerinde travma, özellikle de yanığa bağlı travmalar, halk sağlığı için her zaman bir tehdit olmaya devam edecektir. Terör saldırıları ve meskun mahal savaşları; modern muharebelerin zaman içerisinde klasik meydan savaşlarından nasıl evrildiğini gözler önüne sermektedir. Farklı silahların insane vücudunda sebep olduğu değişik zarar mekanizmalarını bilmek savaş alanında karşılaşılan yanıkların doğru tedavi ve yönetimi için gereklidir. Harp zamanı hem asker hem de siviller yanık yaralanmalarının hedefi olmaya açıktır. Günümüz savaşlarında siviller daha çok hedef alındıklarından sıklıkla zorlu tedavi süreçleri ve uzman düzeyinde tedavi gerektiren yaralanmalara maruz kalmaktadırlar. Yanık yaralanmalarından fiziksel olarak iyileşerek kurtulan yaralılar¸sıklıkla sonraki dönemlerde post travmatik stress bozukluğu gibi akıl ve ruh sağlığını etkileyen durumlarla karşılaşmaktadır. Travma yönetimi kılavuzlarının geliştirilip yaygınlaştırılması, koruyucu techizatların geliştirilmesi, ve tüm dünyada sivillerin korunmasına yönelik anlaşmaların uygulanması; ileriye yönelik alınması gereken önlemlerdir. Sonuç olarak savaş halinde yanık yaralanmalarının tedavi ve yönetimi multidisipliner bir yaklaşım ve çoklu kaynak kullanımı gerektirir. Modern silahların verdiği hasar geçmişe göre daha fazla olsa da tıbbi gelişmeler ve koruyucu önlemler ile survi oranları artmıştır. Savaş hallerinde etkin tedavinin sağlanabilmesi için yanık yönetimine yönelik planlama ve eğitim gelecekte de bir öncelik olarak kalmalıdır.
Anahtar Kelimeler: Savaşla ilgili yanıklar; Sivil yanıklar; Askeri yanıklar; Mortalite; Morbidite
Referanslar
- Giannou, Christos, and Marco Baldan. "War surgery, vol 1. " (2010): 179-180. [Link]
- Kricorian K, Khoshnood K, Chekijian S. Hybrid warfare and public health: Conflicts in Ukraine and Nagorno-Karabakh raise the alarm. Public Health Pract (Oxf). 2022;4:100342. Published 2022 Nov 11. [Crossref] [PubMed] [PMC]
- Baer D, Donaldson R, McKinley T, Guldberg R. Divergence of military and civilian trauma research priorities. Trauma Surg Acute Care Open. 2021;6(1):e000765. Published 2021 Jun 15. [Crossref] [PubMed] [PMC]
- Eldad A. War burns: the blow and the cure. Clin Derma- tol. 2002;20(4):388-395. [Crossref] [PubMed]
- Rautio J, Paavolainen P. Afghan war wounded: experience with 200 cases. J Trauma. 1988;28(4):523-525. [Crossref] [PubMed]
- Zouris JM, Walker GJ, Dye J, Galarneau M. Wounding pat- terns for U.S. Marines and sailors during Operation Iraqi Freedom, major combat phase. Mil Med. 2006;171(3):246-252. [Crossref] [PubMed]
- Cant MR, Naumann DN, Swain C, Mountain AJ, Baden J, Bowley DM. Acquisition and retention of military sur- gical competencies: a survey of surgeons' experiences in the UK Defence Medical Services. BMJ Mil Health. 2024;170(2):117-122. Published 2024 Mar 20. [Crossref] [PubMed]
- 8.Khorram-Manesh A, Goniewicz K, Burkle FM, Robinson Y. Review of Military Casualties in Modern Conflicts-The Re-emergence of Casualties From Armored Warfare. Mil Med. 2022;187(3-4):e313-e321. [Crossref] [PubMed] [PMC]
- Peet, J. L., & Sjoberg, L. (2019). Gender and civil- ian victimization in war. Routledge. [Crossref]
- Atiyeh B.S., Gunn S.W.A., Hayek S.N.: Armed conflicts and burn injuries. Ann. Burns and Fire Disasters, 18: 45-6, 2005. [PubMed]
- Zhang JK, Botterbush KS, Bagdady K, Lei CH, Mercier P, Mattei TA. Blast-Related Traumatic Brain Injuries Second- ary to Thermobaric Explosives: Implications for the War in Ukraine. World Neurosurg. 2022;167:176-183.e4. [Crossref] [PubMed]
- Cheng, Biao, Siming Yang, and Xiaobing Fu. "Introduction to the Repair and Regeneration of War Wound Tissue." Re- generative Medicine in China (2021): 1-56. [Crossref]
- Aviv U, Kornhaber R, Harats M, Haik J. The burning issue of white phosphorus: a case report and review of the litera- ture. Disaster Mil Med. 2017;3:6. Published 2017 Aug 30. [Crossref] [PubMed] [PMC]
- David, N. V., Gao, X. L., & Zheng, J. Q. (2009). Ballistic resistant body armor: contemporary and prospective ma- terials and related protection mechanisms. [Crossref]
- Schneider, J., & Macdonald, J. (2023). Looking back to look forward: Autonomous systems, military revolutions, and the importance of cost. Journal of Strategic Studies, 1-23. [Crossref]
- Goldberg, Matthew S. "Casualty rates of US military per- sonnel during the wars in Iraq and Afghanistan." Defence and peace economics 29.1 (2018): 44-61. [Crossref]
- Khorram-Manesh A, Burkle FM, Goniewicz K, Robin- son Y. Estimating the Number of Civilian Casualties in Modern Armed Conflicts-A Systematic Review. Front Public Health. 2021;9:765261. Published 2021 Oct 28. [Crossref] [PubMed] [PMC]
- Pruitt, Basil A., Steven E. Wolf, and Arthur D. Mason. "Ep- idemiological, demographic, and outcome characteristics of burn injury." Total burn care 4 (2012): 15-45. [Crossref]
- Willy, C., Hauer, T., Huschitt, N., & Palm, H. G. (2011). "Einsatzchirurgie"-experiences of German military sur- geons in Afghanistan. Langenbeck's archives of surgery, 396, 507-522. [Crossref] [PubMed]
- Sloan, Elinor. Military transformation and modern warfare: A reference handbook. Bloomsbury Publishing USA, 2008. [Crossref]
- 21. Borden Institute (US), ed. Emergency War Surgery: 4th United States Revision. Government Printing Office, 2014.547.
- 22 Vargas, J., and ARMY COMMAND AND GENERAL STAFF COLLEGE FORT LEAVENWORTH KS SCHOOL OF ADVANCED MILITARY STUDIES. "Colombia: A country under constant threat of disasters." School of Ad- vanced Military Studies Monograph 1 (2014): 66..
- Sochet, Isabelle, ed. Blast effects: physical properties of shock waves. Springer, 2017. [Link]
- Atiyeh, B. S., S. W. A. Gunn, and S. N. Hayek. "Secretary General, Mediterranean Council for Burns and Fire Disas- ters (MBC), WHO Collaborating Centre, Division Plastic and Reconstructive Surgery, American University of Beirut Medical Centre, Beirut, Lebanon. E-mail: aata@ terra. net. lb 2 President Emeritus, MBC. E-mail: swagunn@ bluewin. ch 3 Plastic and Reconstructive Surgery, University of Min- nesota, Minneapolis, USA." [PMC]
- Seth, Rohit, D. Chester, and Naiem Moiemen. "A review of chemical burns." Trauma 9.2 (2007): 81-94. [Crossref]
- Beal, Samuel A., and Matthew F. Bigl. "Particle Size Characteristics of Energetic Materials Distributed from Low-Order Functioning Mortar Munitions." Journal of En- ergetic Materials (2022): 1-16. [Crossref]
- Yang, Ce. "Defense Against Blast Injury." Explosive Blast Injuries: Principles and Practices. Singapore: Springer Na- ture Singapore, 2023. 117-141. [Crossref]
- Schorscher N, Kippnich M, Meybohm P, Wurmb T. Lessons learned from terror attacks: thematic priorities and devel- opment since 2001-results from a systematic review. Eur J Trauma Emerg Surg. 2022;48(4):2613-2638. [Crossref] [PubMed] [PMC]
- Bieler D, Franke A, Kollig E, et al. Terrorist attacks: com- mon injuries and initial surgical management. Eur J Trauma Emerg Surg. 2020;46(4):683-694. [Crossref] [PubMed]
- Aschkenasy-Steuer G, Shamir M, Rivkind A, et al. Clini- cal review: the Israeli experience: conventional terrorism and critical care. Crit Care. 2005;9(5):490-499. [Crossref] [PubMed] [PMC]
- Bukowski, Josh, et al. "High risk and low prevalence dis- eases: Blast injuries." The American Journal of Emergency Medicine (2023). [Crossref] [PubMed]
- Carlton E, Weber EJ. Lessons learnt in ethical publishing from mass casualty events: the Manchester bombing ex- perience. Emerg Med J. 2021;38(10):744-745. [Crossref] [PubMed]
- Tomonaga, M. (2019). The Atomic Bombings of Hiroshi- ma and Nagasaki: A Summary of the Human Consequences, 1945-2018, and Lessons for Homo sapiens to End the Nu- clear Weapon Age. Journal for Peace and Nuclear Disarma- ment, 2(2), 491-517. [Crossref]
- Bradley, Matthew, et al. "Combat casualty care and lessons learned from the past 100 years of war." Current problems in surgery 54.6 (2017): 315-351. [Crossref] [PubMed]
- Laskin JD, Wahler G, Croutch CR, et al. Skin remodeling and wound healing in the Gottingen minipig following ex- posure to sulfur mustard. Exp Mol Pathol. 2020;115:104470. [Crossref] [PubMed] [PMC]
- Page, Felicity, et al. "Epidemiology of UK military burns 2008-2013." Journal of Burn Care & Research 38.1 (2017): e269-e276. [Crossref] [PubMed]
- Martovytskyi, Dmytro, Anastasiia Melenevych, and Dmytro Molotyagin. "Diseases of internal organs in combat surgical trauma and injuries in catastrophes and accidents in peace- time. Diseases caused by exposure to thermal factors (heat and cold)." (2022). [Link]
- Montini, Federico Tenca. "THE BURNING BORDER. A comparative study of the problem of Trieste and other territorial issues confronted by Italy after defeat in the Second World War." http://dx.doi.org/10.17234/RadoviZHP.51.18 [Crossref]
- Gurney, Jennifer, Matthew D. Tadlock, and Leopoldo C. Cancio. "Burn Injuries from a military perspective." Cur- rent Trauma Reports 8.3 (2022): 113-126. [Crossref]
- Margalit, Alon. "Investigating civilian casualties in time of armed conflict and belligerent occupation: manoeuvring be- tween legal regimes and paradigms for the use of force." Investigating Civilian Casualties in Time of Armed Conflict and Belligerent Occupation. Brill Nijhoff, 2018. [Crossref]
- Roberts, Adam. "Lives and statistics: Are 90% of war vic- tims civilians?." Survival 52.3 (2010): 115-136. [Crossref]
- Champion, Howard R., et al. "A profile of combat injury." Journal of Trauma and Acute Care Surgery 54.5 (2003): S13-S19. [Crossref] [PubMed]
- Foster, Mark Anthony, Jamil Moledina, and Steve LA Jef- fery. "Epidemiology of UK military burns." Journal of burn care & research 32.3 (2011): 415-420. [Crossref] [PubMed]
- Yaacobi, Dafna, et al. "Burns in the Military Setting- Analyzing 12,799 Routine and Combat Cases." Journal of Burn Care & Research 42.1 (2021): 67-70. [Crossref] [PubMed]
- Zheng, Xing-feng, et al. "Management of combined mas- sive burn and blast injury: a 20-year experience." Burns 46.1 (2020): 75-82. [Crossref] [PubMed]
- Schauer, Steven G., et al. "A conceptual framework for non-military investigators to understand the joint roles of medical care in the setting of future large scale combat op- erations." Prehospital Emergency Care 27.1 (2023): 67-74. [Crossref] [PubMed]
- Anagnostou, Evangelos, Athanasios Michas, and Christos Giannou. "Practicing military medicine in truly austere en- vironments: what to expect, how to prepare, when to impro- vise." Military medicine 185.5-6 (2020): e656-e661. [Crossref] [PubMed]
- Hughes, Amy, et al. "Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020." Burns 47.2 (2021): 349-370. [Crossref] [PubMed] [PMC]
- Lee, Joseph J., et al. "Integrated military and civilian part- nerships are necessary for effective trauma-related training and skills sustainment during the inter-war period." Journal of Trauma and Acute Care Surgery 92.4 (2022): e57-e76. [Crossref] [PubMed]
- Wolf SE, Kauvar DS, Wade CE, et al. Comparison be- tween civilian burns and combat burns from Operation Iraqi Freedom and Operation Enduring Freedom. Ann Surg. 2006;243(6):786-795. [Crossref]
- Lodha, P., et al. "Post-traumatic stress disorder (PTSD) fol- lowing burn injuries: a comprehensive clinical review." An- nals of burns and fire disasters 33.4 (2020): 276. [PMC]
- Grieve, Brian, et al. "Long-term social reintegration out- comes for burn survivors with and without peer support attendance: a Life Impact Burn Recovery Evaluation (LI- BRE) Study." Archives of physical medicine and rehabil- itation 101.1 (2020): S92-S98. [Crossref] [PubMed] [PMC]
- Uddin, Helal, Md Khalid Hasan, and Rafael Castro-Delga- do. "Effects of mass casualty incidents on anxiety, depres- sion and PTSD among doctors and nurses: a systematic review protocol." BMJ open 13.9 (2023): e075478. [Crossref] [PubMed] [PMC]
- Wolf, Lisa A., et al. "Traumatic stress in emergency nurses: does your work environment feel like a war zone?." Inter- national emergency nursing 52 (2020): 100895. [Crossref] [PubMed]
- Dootz, Felix, et al. "Better be prepared: the spectrum of neuropsychiatric impairment among Libyan war victims transferred to Germany for trauma rehabilitation." Neuro- logical research and practice 3 (2021): 1-9. [Crossref] [PubMed] [PMC]
- Gauglitz, Gerd G., and F. N. Williams. "Overview of the management of the severely burned patient." UpToDate, Waltham, MA.(Accessed on March 29, 2016.) (2020). [Link]
- Hoch, Emily, et al. "Mitigating the Effects of Blast-Related Burn Injurie s from Prolonged Field Care to Rehabilitation and Resilience." (2020). [Link]
- Khorram-Manesh, Amir, et al. "Review of military casu- alties in modern conflicts-the re-emergence of casualties from armored warfare." Military medicine 187.3-4 (2022): e313-e321. [Crossref] [PubMed] [PMC]
- Bendavid, Eran, et al. "The effects of armed con- flict on the health of women and children." The Lancet 397.10273 (2021): 522-532. [Crossref] [PubMed]
- Levy, Adi, and Michael L. Gross. "How moral injury and combat trauma drive political activism and societal reinte- gration among Israeli veterans." [Crossref] [PubMed] [PMC]
- 61. Agarwal, Divyansh, et al. "Reciprocal learning be- tween military and civilian surgeons: past and future paths for medical innovation." Annals of Surgery 274.5 (2021): e460-e464. [Crossref] [PubMed] [PMC]
- Atiyeh, Bishara S., S. W. A. Gunn, and S. N. Hayek. "Mil- itary and civilian burn injuries during armed conflicts." Annals of burns and fire disasters 20.4 (2007): 203. [PubMed]
- Schwab, C. William. "Winds of war: enhancing civilian and military partnerships to assure readiness: white paper." Journal of the American College of Surgeons 221.2 (2015): 235-254. [Crossref] [PubMed]