Oman - A Limited Experience
the Royal Naval Medical Services Vol 63 Summer 1977
deputised in September 1976 when the army surgeon was recalled
He defines the problems
that arise as a result of the war and the presence of Adoo
He notes that "
the only commodity not freely available was blood. This was so
to bleed "on the hoof". If blood was required in an emergency
for a major casualty, the requirement for the blood group was
broadcast on Radio 219.... picked up on medium wave by all local
expatriots.... at least 30 donors would attend within 10
- isolated skirmishes
between border patrols from the Yemen and border patrols
from the Sultan of Oman's Forces
- occasional Adoo
contact throughout Dhofar Province mainly in the jebel
- the presence of
large numbers of anti-personnel mines planted during the war
as yet uncleared and to a large extent uncharted.
- road traffic
accidents involving vehicles of the Sultan of Oman's Forces,
- isolated accidental
discharges from weapons, burns and routine general practice
describes five cases :
Case Report 1.
Thenar eminence injury in an Iranian Corporl from an accidental
Case Report 2.
Forearm injury in an Iranian Sergeant. The same bullet that had
injured Case 1
Case Report 3.
A Balouchi Sergeant who had stepped on an APM and
sustained a traumatic amputation of the left foot.
Case Report 4.
SAF Officer who had stepped on an APM and sustained the
- traumatic amputation
of the right leg
- comminuted compound
fracture of the right forearm with tissue loss
- massive tissue loss
- puncture wounds to
the left hand
- blast wounds to the
posterior aspect of his left leg.
He was bleeding faster
that fluids were being replaced even though he had several iv
lines. Accordingly he was anaesthetised and a through knee
amputation was carried out whilst resuscitation continued. Once
his vital signs had improved surgical debridement continued.
Wounds were packed with Chloros soaked packs. From a hole in his
buttock the heel of his DMS boot was recovered.
Surgery lasted seven
hours and he was transfused with 17 units of whole blood. He was
evacuated to Queen Mary's Hospital at Roehampton after 48hrs.
Case Report 5
A Royal Engineer Sapper engaged in clearing a minefield who
stepped on an APM. Seen 35 mins after injury with a traumatic
amputation of the right foot and blast injuries to the left leg.
The right foot had been
destroyed but the tiba and the fibula were intact. There was
severe muscle damage with foreign bodies within the muscle
planes 10cms higher than the level of major injury. DPS at
four revealed a significant amount of de-vitalised tissue.
Further debridement and tibia/fibula amputation was required and
the wound was closed lightly around a pack and a pressure
dressing was applied.
In the discussion part of
the paper he reflects on the reasons why so few people died.
- The relatively small
number of casualties seen at the FST
- Their arrival singly
rather than as a group
He reflects on the time
taken from wounding to resuscitation
- World War II
4 to 5 hours
1.5 to 2 hours
1.5 to 2 hours
1.5 to 2hrs
He comments that transit
time from wounding to FST in Oman was about 35mins.
He observes that the
length of time taken to anaesthetise and operate on the most
severely wounded wound be unacceptable in a situation where
there were a large number of casualties who not so severely
wounded and could be saved.
He ruefully comments on
the need for adequate primary debridement (Case 5)
He calls for more Naval
Officers to be given the opportunity to gain FST experience.
In Spring of
'72 FST time from injury to surgery was 4.6
hours. This did include some very long waits in
which people had been wounded up to thirty six
hours before hand and could be refined rather
than just taking the figures off the
In the only
experience that I have had of mass casualties -
the RCL into the officers mess and the
casualties from Mirbat
- the most severely wounded can be
saved and those waiting for surgery can be
stabilised and supervised by FST members who are
prepared to multi-task in a sometimes unorthodox
way. See "Documents" "The
Spring of 1972 it was not the policy to
resuscitate the wounded and then proceed to
surgery. Wounded only bleed more quickly as
their blood pressure rises and with every unit
of blood transfused the chances of clotting
anomalies increases. Increased tendency to
electrolyte imbalance may occur which is a
problem if the means of assessing electrolytes
is not provided. Time spent resuscitating the
wounded is time when some useful surgery could
be initiated and completed - you never know when
the next casualty will arrive. If you fail to
reach your ideal point where you declare them to
be resuscitated you are then forced to
anaesthetise them when they are in possibly a worse
condition than when you started the
process. See Case 4 above. Resuscitation was
combined with surgery which prevented further
deterioration before electrolyte imbalance and
coagulation defects had the chance to occur.; both
anaesthesia and surgery were implemented as
quickly as was practically possible. I admit to
being of an impatient nature but the surgeon was
pro-active as well!