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Industry: Email Alert RSS FeedCroatian Medical Corps in Bosnia and Herzegovina during the 1992-1995 War
Military Medicine, Nov 2003 by Bagaric, Ivan, Eldar, Reuben
Medical Care Rendered
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In the fighting with Serb forces, there was a regular front line because they acted according to the classical warfare doctrine of the Yugoslav Army, using artillery armored vehicles and infantry with shelling of the rear. This imposed the deployment of physicians (second echelon) very near to the front line, where they could take care of casualties quickly, infusing with a crystalloid solution (Ringer's) and Dextran 70, giving pethidine (100 mg intramuscularly) or morphine (10 mg intramuscularly), applying first dressings, and immobilizing with splints, as well as attention to airways. From these first-aid stations, casualties were transported by fellow soldiers or medical technicians to a brigade medical station where advanced resuscitation (nonsurgical hemostasis, attention to airways with an endotracheal tube, and ventilation using an Ambu bag, placement of a secure intravenous line) was undertaken. These stations were purposefully positioned from a few hundred meters to 2 km from the front line so that casualties could reach them within less than 1 hour of injury. From there, they would be transported to a war hospital, reached usually within 1 to 2 hours of being wounded.12,15 In contrast, during the conflict with Bosniacs, fighting within cities was typical, and the echelon principle was not applicable. Instead, casualties were taken directly to the nearby war hospital, which was very close to most sites of fighting.
On admission to war hospitals, all casualties were triaged and received antitetanus prophylaxis and initial administration of penicillin, metronidazole, and garamycin, according to the Falkland Island's experience.24 Casualties received definitive treatment, including laparatomies, thoracotomies, major debridements, reamputations, lobectomies, osteosynthesis of limbs with external fixation, and large vessel reconstructions using grafts of saphenous veins.12,14,15,17 Surgical interventions were performed in 17%16 to 56%14 of casualties under general anesthesia in 50% of operations.14-16 Many hospitals had intensive care units for immediate postoperative care.15-17 Casualties who after surgery needed longer periods of recovery and rehabilitation as well as the most serious cases (brain injuries) were, after an appropriate preparation for transport, evacuated further to Croatia, usually to Split.12-15,17,20,21 Fifty percent of casualties were retained and 11% were evacuated sometimes with the help of the Red Cross.12 This necessitated travel by ambulance for 117 to 4 hours14,16 and even 8 hours.12 Only very rarely (from Croat-controlled areas of Central Bosnia) evacuation was performed with helicopter.14 Blood transfusion was based on collection from local blood donors who had their blood groups, Rh factor, and serology previously determined in the war hospital laboratories.14,15 War hospitals took care not only of war casualties (both Croats and Bosniac, as well as some Serbs) but also served as facilities for the health care of the local population. One of the hospitals set up gynecological, pediatric, and infectious diseases wards,13 and in another more than 1,200 children were born, 25 of these by caesarean section, during its 3 years of operation.17
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