Awful face of the war-impacted smoke bomb capsule in the face and systemic toxicity: reports from the conflict in Syria.

In this study, a rare kind of injury due to smoke bomb capsule impaction to midface and under the cranial base is presented, and maneuvers to reduce mortality are discussed. Three male patients were presented with impacted smoke bomb capsules into the midface and under the cranial base structures. Midface structures, anterior cranial base, and, in 2 patients, unilateral eye were severely damaged. Two patients died after the initial emergency operations because their lung disease progressed to acute respiratory distress syndrome. One of the patients lived, and soft tissue reconstruction was achieved by using temporal transposition and cheek advancement skin flaps with split-thickness skin graft from donor site. However, craniofacial destruction is important in these patients; a multidisciplinary approach is needed for the treatment of direct smoke bomb injuries because the patients experienced chemical burn and acute trauma. The timing of maxillofacial reconstruction is also a question in these specific patients.

A laser driven pulsed X-ray backscatter technique for enhanced penetrative imaging.

X-ray backscatter imaging can be used for a wide range of imaging applications, in particular for industrial inspection and portal security. Currently, the application of this imaging technique to the detection of landmines is limited due to the surrounding sand or soil strongly attenuating the 10s to 100s of keV X-rays required for backscatter imaging. Here, we introduce a new approach involving a 140 MeV short-pulse (< 100 fs) electron beam generated by laser wakefield acceleration to probe the sample, which produces Bremsstrahlung X-rays within the sample enabling greater depths to be imaged. A variety of detector and scintillator configurations are examined, with the best time response seen from an absorptive coated BaF2 scintillator with a bandpass filter to remove the slow scintillation emission components. An X-ray backscatter image of an array of different density and atomic number items is demonstrated. The use of a compact laser wakefield accelerator to generate the electron source, combined with the rapid development of more compact, efficient and higher repetition rate high power laser systems will make this system feasible for applications in the field. Content includes material subject to Dstl (c) Crown copyright (2014). Licensed under the terms of the Open Government Licence except where otherwise stated. To view this licence, visit http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@ nationalarchives.gsi.gov.uk.

Characteristics of ballistic and blast injuries.

Ballistic injury wounds are formed by variable interrelated factors, such as the nature of the tissue, the compositional makeup of the bullet, distance to the target, and the velocity, shape, and mass of the of the projectile. This complex arrangement, with the ultimate outcome dependent on each other, makes the prediction of wounding potential difficult to assess. As the facial features are the component of the body most involved in a patient's personality and interaction with society, preservation of form, cosmesis, and functional outcome should remain the primary goals in the management of ballistic injury. A logical, sequential analysis of the injury patterns to the facial complex is an absolutely necessary component for the treatment of craniomaxillofacial ballistic injuries. Fortunately, these skill sets should be well honed in all craniomaxillofacial surgeons through their exposure to generalized trauma, orthognathic, oncologic, and cosmetic surgery patients. Identification of injured tissues, understanding the functional limitations of these injuries, and preservation of both hard and soft tissues minimizing the need for tissue replacement are paramount.

Measures for emergency medical technicians in helping victims at scenes guided by the pattern of injuries and bombing attacks in the three most southern provinces of Thailand.

Bombing attacks by terrorists in the three most southern provinces of Thailand increased both in frequency and intensity from the year 2004 until now. Patterns of bombing were not only destroying buildings or killing targets victims by dropping bombs under roads and in public places but also harming scene investigators by dropping second bombs nearby. Emergency medical personnel working there also had some risks from these second bombs while helping victims at the scene. The purposes of the present study aimed to describe patterns and risks of bombing attacks, analyze locations of wounds of bombing casualties and propose a standing operation procedure for emergency medical technicians (EMTs) in helping victims at scenes to reduce harm from second bombs. The authors gathered some information about patterns of bombing from the Forward 4th Army Area Explosive Ordnance Disposal (EOD) team and reviewed insurgency related casualty reports from Yala, Pattani and Narathivasrajanakarin Hospital from January 2004 to December 2006. From these reports, data of deep wounds or wounds that caused serious injuries or deaths of 144 improvised explosive devices (IED) victims was collected and separated into fatal (45 casualties) and nonfatal groups (99 casualties). In each group, casualties' demographic data and number of casualties separated by locations of wounds and occupations are shown and compared by percentage of the total number of each group and was found that most of fatal casualties had wounds on head (42.22%), chest (33.33%) and abdomen (33.33%) that should be protected by wearing helmets and body armors. But there was a higher proportion of extremity injuries in non-fatal casualties (63.64%). Thus, the authors proposed measures for EMTs in helping victims at scenes to reduce their risks by wearing helmets and body armors and quickly removal of the injured with minimal medical intervention.