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H Husum, M Gilbert, T Wisborg. (Pp 226). Third World Network, 2000. ISBN 983-9747-42-8
“Save lives save limbs” by Hans Husum and his colleagues is a book that is attractive, full of information, and, although at times it reads like a heart tugging novel, it retains a high educational value. In a concise and well illustrated manner the book describes the total care of the victims of anti-personnel weapons. It should appeal to everyone interested in trauma and is, in my opinion, obligatory for all those who find themselves working outside the luxurious resources of Western hospitals. The authors have substantial experience of working in adversity and they try to offer a solution to the inadequate resources usually found where most of these injuries occur.
It begins with a well illustrated description of the types of mines and the injuries they cause. The description left me wondering what sort of person actually sits down and designs these ghastly devices. Perhaps even more amazing is the thought that many highly respected members of Western communities live well on the profits from this lethal trash.
ATLS techniques are described in detail and there is an excellent theme of damage control in trauma care. Technical details are supported by the simple philosophy that everyone can learn the basic techniques of life and limb preservation and once learnt it is our duty to pass on the knowledge. The simple statements and clear illustrations, often in cartoon form, prove that the authors themselves fully follow this ideal and urge the concept of the “Village University”.
There is an academic quality to this book as well as practical advice on immediate care, surgical techniques, anaesthesia, and nutrition. The physiological importance of fear is emphasised with an example of how to calm a patient while organising their removal from a minefield—a vital but common form of prehospital care in the real world. Every subject is illustrated by, inspiring, examples of ordinary people—some qualified in medicine or nursing and others not—who have saved life and limbs by using their skills.
Trauma specialists are no use if they are three days travel away from the casualty. The possession of higher surgical qualifications at a distance count for nothing compared with limited but immediately. An impressive proof of this fact is the use of limited laparotomy when isolated from a major hospital. The book describes how to stop bleeding and leave the complex visceral repair to the “experts” after transfer. There is an excellent example of an Afghanistan nurse successfully undertaking imperative “damage control” laparotomy for intra-abdominal bleeding; movement of the casualty to a hospital was not immediately possible because of the likelihood of aerial fighter attack during daylight hours! Quite possibly this type of treatment would lead to a reduction in the incidence of the increasingly recognised “abdominal compartment syndrome”.
Very few engaged in trauma care would fail to gain some new knowledge or insight from this excellent, ”one sitting read”. Despite its simple format the book is an excellent text for UK trainees and demonstrates universally applicable methods while using common sense to underline theory.
The book confirms that “knowledge is power” but especially when it is shared. It is obviously aimed at developing countries but I would recommend that this book find a place in all NHS hospital libraries. Perhaps when junior doctors in the United Kingdom are feeling overworked and consultants believe that they are underpaid a review of this remarkable work would lead them to ponder on their good fortune.