At a minimum, these patients should be isolated from the rest of the hospital to eliminate possible collateral damage from premature detonation. Although no instances of explosion have occurred, the risk of losing critical personnel and equipment resources is too great. A stretcher, gurney, and equipment necessary to remove the round should be moved to an isolated, protected area (bunker, sand pit, parking lot). Once the round is removed, the patient can be moved to the operating room for definitive care. Personnel protective equipment in the form of flak vests, headgear, and sandbag barriers around the patient should all be used.The article's references [page 4] list several Vietnam news items about these surgeries:
The least amount of anesthesia necessary should be used. If a lower extremity or lower abdominal injury has occurred, a spinal anesthetic may be sufficient. The anesthetic should be placed so that the anesthesia provider does not need to be with the patient during removal. Nonflammable anesthesia without supplemental oxygen should be used to lessen collateral injury in case of detonation.
Minimal dissection of tissues should be done at the time of removal. En bloc resection of the surrounding tissues with the involved round lessens the chance of inadvertent metal-to-metal contact and overall manipulation of the round. Metal instruments should not touch the round, if possible, because this may also trigger an explosion. After the round has been removed, the patient should be transported to the regular operating theater, where the surgical procedure can then be safely completed.
• Doctor digs live shell out of soldier. Pacific Stars and Stripes, October 3, 1966.During training in 2001, a Colombian soldier was accidentally shot in the face (note x-ray) with a grenade: it took four hours to remove it.
• Surgeon cuts out grenade. Pacific Stars and Stripes, December 10, 1967.
• Surgeon digs live shell from GI's abdomen. Pacific Stars and Stripes, January 26, 1968.
• Doctor removes live grenade from GI's leg. Pacific Stars and Stripes, March 27, 1968.
• Live grenade: deadly dilemma for doctor. Pacific Stars and Stripes, March 22, 1970.
Lieutenant Commander David A. Taft removed an embedded, armed, 2.76-inch rocket by amputation from a wounded marine. The rocket detonated unexpectedly after the extraction, fortunately wounding no one. Sergeant Daniel Henry, USMC, helped Taft with ordnance information during the operation. Henry was awarded the Silver Star for his bravery, but unfortunately was killed in a mortar attack 2 months later. His name is memorialized on The Wall in Washington DC.Accompanying the article are two X-rays from other incidents: see Figure 1 (mortar round in chest) and Figure 2 (grenade in thigh).
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posted by alby at 11:35 AM on September 22, 2007