Management of Limb Injuries

During disasters and conflicts


In disasters, up to 90% of the surgical workload faced by national and international emergency medical teams involves limb injury. The need has never been greater for clear practical guidance for surgical teams to practice safe, effective limb injury care fit for the context of conflict or disaster, and not necessarily what they do in normal daily practice.

The WHO Emergency Medical Team (EMT) Initiative helps countries and NGOs to set up teams that will be able to maintain agreed standards of quality and self-sufficiency, resulting in better patient care. With more teams striving to reach these standards, clear guidance on best practice is needed, particularly for managing patients with limb injuries, which make up the majority of cases.

Read more on the WHO Emergency Medical Teams website.

Content by chapter

  • 1. Context
    • Triage
    • Phases of disasters
    • Burden of disease in sudden onset disasters
    • Earthquakes / Tsunamis / Floods
    • Healthcare in danger
    • Patient factors
  • 2. Ballistics
    • Ballistics & Energy Transfer
    • Bullet wounds
    • Blast injuries
    • Management
  • 3. Logistics, field support and training
    • Logistics and self-sufficiency
    • Logistics standards
    • Training for EMTS
    • Considerations for training
  • 4. Anesthesia and perioperative care
    • Initial assessment
    • Pre-operative care
    • Post-operative care
    • Anaesthesia
    • Pain management and patient record
  • 5. Damage control surgery and resuscitation
    • Principles of damage control surgery and resuscitation
    • Resuscitation and pelvic fractures
    • Diagnosis and management
    • Placement of anterior frames for pelvic fractures
  • 6. Limb wounds
    • Wound management
    • Wound surgery
    • Wound debridement by layers
    • Dressings
  • 7. Closed fractures
    • Closed fracture management
    • Immobilization
    • After-care and follow up
    • Removing casts
    • Traction
    • Paediatric considerations
    • Transfers
    • Management of closed fractures with internal fixation
  • 8. Open fractures
    • Wound debridement
    • Fracture stabilization
    • External fixation for open fractures
    • Management of open fractures
  • 9. Compartment syndrome and crush syndrome
    • Compartment syndrome diagnosis
    • Compartment syndrome treatment
    • Crush syndrome
    • Crush syndrome management in SODs
  • 10. Amputations
    • Lower extremity amputations
    • Specific technical considerations
    • Upper extremity amputations
    • Special considerations
    • Complications of amputation
    • Key messages regarding amputation
  • 11. Burns
    • Clinical management of burns
    • Surgical management of burns
    • Chemical and electrical burns
  • 12. Ethics of healthcare in disasters and conflicts
    • Main ethical theories
    • Tools to deal with ethical dilemmas
    • EMT guiding principles
    • Research ethics in disasters
  • 13. Rehabilitation
    • Acute care treatment
    • Sub acute treatment
    • Chronic-long term treatment
    • Family involvement and equipment
  • Annexes
    • ICRC ABCD initial assessment
    • ICRC Burns Overview
    • ICRC Thromboprophylaxis guideline
    • ICRC Triage
    • ICRC Femur Fracture and Traction

An initiative of the AO Foundation and the International Committee of the Red Cross.
In collaboration with The World Health Organization EMT Secretariat

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