The BMJ Today: Surgery in a war zone

Deborah CohenNothing else comes close to the enjoyment of being able to help people in a war zone,” says London based vascular surgeon David Nott in BMJ Confidential.

For two decades he has taken around six weeks, unpaid leave almost every year to provide help and to train doctors in war zones, starting in Sarajevo in 1993 and most recently in Syria.

Last year, while stationed in Aleppo, Nott released an x-ray image that became global front page news. It showed an unborn baby with a bullet lodged in its skull—the result of pregnant women being targeted by snipers.

It’s not the first time that the BMJ has interviewed Nott. Back in 2008, while on a ward round working for Médecins Sans Frontières in the Democratic Republic of Congo, he came across a 16 year old boy who needed an emergency forequarter amputation. Never having done one before—but realising the boy would die without one—he contacted his colleague, Professor Meirion Thomas, at the Royal Marsden Hospital, whom Nott believed to have the “greatest experience with forequarter amputation in the UK.”

Through a series of detailed text messages from Thomas, and hours of planning the procedure on pieces of paper, Nott carried out the procedure successfully. Read the full text exchange here.

In BMJ Confidential, Nott says that what has made the biggest difference in his specialty is his understanding of the physiology of trauma. “It allows me to do what is right for the patient in any environment I find myself,” he says.
He is putting that knowledge to good use. With funds from the Department for International Development, he is training doctors who have expressed an interest in doing humanitarian medical work via the UK International Emergency Trauma Register in surgical practice in warzones.

For those interested in learning more about emergency surgery, Munawar Al-Mudhaffar and Philip Hormbrey describe the basics of assessing abdominal trauma. “To avoid missing significant injuries, one must assume that every major trauma patient has suffered an abdominal injury unless the patient is awake, has no abdominal pain or distracting injuries, and has normal vital signs,” they say.

Deborah Cohen is investigations editor, The BMJ.