Журнал травм и лечения

Characteristics, Outcomes, and Implications for Care of Firearm Injuries During Unrest in a Conflict Zone of India: A Clinical Retrospective Study

Abstract

Tabish Syed Amin, Ennas Chowdary, Neelam Kotwal and Shahnawaz Hamid

Background: Violence and Injuries are a significant global public health concern characterized by marked regional variation in incidence. It is estimated that violence and injuries account for 9% of all the global deaths. Violent injuries are the eighth leading cause of death, worldwide Developing countries carry the largest burden of injuries and approximately 90% of the deaths due to injuries occur in low and middle-income countries. Injuries also impose a huge financial burden among communities. High death toll firearm injuries cause significant morbidity, long-term physical and psychological disability for individuals, families, communities and society. Violence is a dynamic process. Large scale violence may take the form of mass uprising against oppression of dominant class. Such types of violence erupted in Kashmir (Northern India) since 1989 that left more than 65 thousand people killed and tens of thousands injured.
Objective: To study the characteristics, outcomes, and implications for care of firearm injuries during unrest in a conflict zone of India
Methods: A clinical retrospective cohort study of patients, all due to firearm-related injuries, was conducted between July 1, 2016, to December 31, 2016, at a large tertiary care teaching hospital (SKIMS) at Srinagar where majority of ballistic trauma patients report to Emergency Department for treatment. Medical records of all patients admitted were studied and the important details were recorded.
Results: The study showed that the firearm injury is more frequent in very young adults. The most common cause of firearm injury was bullets followed by pellets, tear gas shells and blast injury. Majority of injuries were due to Pellets 149 cases (62.08%), followed by Shells 45 (18.75%), Bullets 39 (16.25%) and Blasts 7 (2.91%). Upper limb involvement was 25% followed by head & neck (23%), lower limb (20%), chest and spine (17%), and abdomen (15%). The majority had injuries like fracture, haemothorax, brain contusions, vascular injury, lung contusions, pneumothorax etc. Majority of the patients were managed consevatively. Surgical interventions were performed in rest of the cases. Firearm injuries were detected mainly on head and neck region followed by chest region. Eye injury was observed in 8.33 percent patients. Mortality was slightly more than 5 percent in these patients, primarily due to bullet injuries followed by pellet injuries.
Conclusion: Considering the high volume of the injured, the situation in Kashmir is volatile and as such needs high-quality trauma care centers across the state to reduce the firearm related morbidity and mortality. Moreover, an Advanced Trauma Centre needs to be established in the capital city of Srinagar. A sound and dependable referral system will go a long way to avoid inconvenience to the patients, save the lives and limbs and reduce disability.