Experiences of Australian Army theatre nurses - Statistical Data Included

AORN Journal,  Feb, 2002  by Narelle Biedermann

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Ms G discussed the contamination of the wounds that were seen in the 1st Australian Field Hospital theatres, and the challenges they presented to the medical and nursing staff members were significant. Bullet wounds commonly were inflicted by Soviet-made AK-47 rifles. This weapon discharges lightweight rounds at a high velocity, which creates greater kinetic energy than weapons that have a lesser velocity. These smaller, lightweight bullets consequently create larger temporary and permanent cavities in body tissue and cause significantly more severe tissue damage than low-velocity projectiles.

Due to their slight weight and speed, the rounds were easily deflected by foliage, which caused them to tumble and spin, causing even larger entrance wounds. The bullets usually disintegrated in the body and rarely were found intact, even when there was no exit wound. (2) A further problem that complicated resuscitation and treatment was that the weapons were rapid-fire; hence, more rounds were ejected from the weapon in a shorter time frame, increasing the likelihood of multiple wounds.

Another weapon that caused multiple wounds, the claymore mine, was used extensively by both sides in the Vietnam War. The concentrated peppering of thousands of ball bearings and the velocity with which the fragments traveled often resulted in deep penetration in multiple sites. The comprehensive use of these and other mines in Vietnam contributed to another medical quandary. The proximity of the blast caused severe local destruction, and immeasurable amounts of dirt, debris, and secondary missiles were launched into the wound. Extensive contamination of the multiple wounds often challenged the surgeon to select between radical excision of possibly salvageable tissue and a more cautious approach that might leave a source of infection.

An aspect of theatre maintenance for which Ms G was responsible was ensuring that the surgical equipment and instruments were sterilized and ready for use. She recalled that this occasionally was quite difficult.

   We had to always be up to date with our sterilization and things like that
   ... because sterilizing was very primitive.... We had a World War II
   sterilizer [that] was run on kerosene, and you had to keep your stocks up
   ... you couldn't put a lot into it, so that was a lot of hard work.

Midway through Ms G's tour, much of the equipment used in the operating theatre, such as the instrument sterilizer, was upgraded to match equipment used in large civilian hospitals at the time. Approval was given for the theatres to be rebuilt in late 1968, and just weeks before Christmas, the new air-conditioned theatres were opened. There now were two large theatres so that the surgeons could perform two major procedures simultaneously; however, there was no significant increase in staffing. Ms G described the new theatres as "wonderful" because they no longer leaked when it rained.

She described her role as coordinator of the operating theatre, which included taking part in the triage and transition of casualties to the theatre and into recovery. She also was responsible for allocating the theatre medics to incoming cases and ensuring that staff members, including surgeons, were relieved for regular breaks. Like her predecessor, she was the only theatre nurse, and she found it difficult to get involved in surgical procedures and run the theatre at the same time. "We could have well done with two or three [nurses] in there. When we were busy, it was just bedlam." She indicated that she would scrub for neurological and vascular procedures because the medical assistants did not have experience for those procedures, but she also would try to scrub for less complex procedures on occasion to keep her skills current.