Welcome to the war zone: Cape Town trauma doctors adopt battlefield medicine

19 February 2019 - 16:45 By SIPOKAZI FOKAZI
Professor Andrew Nicol, head of trauma at Groote Schuur Hospital, with a stab-wound patient.
Professor Andrew Nicol, head of trauma at Groote Schuur Hospital, with a stab-wound patient.
Image: Esa Alexander

Violence is getting so intense in the Western Cape that trauma specialists are increasingly using "war-zone" medical strategies in their efforts to save lives.

Professor Andrew Nicol, head of trauma at Groote Schuur Hospital, said over the past decade trauma cases had increased and injuries were becoming more complex.

Easy access to firearms was putting such a huge burden on health services that at Groote Schuur gunshots were the leading driver of intricate surgeries in the trauma unit.

"The major reason we operate these days is due to firearms. It has taken over motor accidents as the number one reason for surgery and trauma," said Nicol.

"We still see more car accident injuries, but they don't require us [the trauma unit] to operate."

While a decade ago trauma centres usually saw single-shot wounds, Nicol said over the last few years they had been seeing multiple gunshot wounds that could easily result in deaths within a short space of time in less-resourced centres.

One war-zone technique used increasingly at the hospital is a shunt, which is used to restore blood flow to patients with damaged arteries who otherwise would bleed to death. Doctors use the shunt to create a "bypass" in the damaged artery.

"We tighten the bleeding artery on both sides and use the shunt to bypass and restore blood flow into the injured area," said Nicol.

"People started to talk about this concept about 10 years ago to avoid deaths before surgery. Due to complexity of violence that we see, we seem to be doing more of these. They often do this in war zones. We call it damage-control surgery."

Nicol was addressing the media at a briefing about the impact of violence and trauma on health services during the festive season.

He said the strategies SA trauma doctors used were drawing a lot of international interest, with doctors from first world countries such as the US, Canada and Europe coming to SA to specialise in the treatment of trauma and emergency medicine.

During the festive season, more than 30,000 emergency patients were delivered to health centres in the Western Cape by ambulance.

Of these, 23% (8,069) were patients who sustained injuries from violent trauma such as stabbings, gunshots and violence.

The top three causes of trauma were:

  • Assault with a weapon: 2,894
  • Physical assault: 956 
  • Accidental injury: 864

Treating a gunshot injury cost the state at least R22,000 a patient, with an extra R25,000 if the victim also required orthopaedic surgery, he said. 

Western Cape health MEC Nomafrench Mbombo
Western Cape health MEC Nomafrench Mbombo
Image: Health-e.org

Western Cape health MEC Nomafrench Mbombo said the abuse of alcohol and drugs were the major drivers of interpersonal violence and injuries seen by provincial hospitals.

Trauma cases increased from 9,000 a year at Groote Schuur Hospital five years ago to about 12,000 in 2018. Mortuaries were also taking strain due to the caseload, which increased by 17% between 2010 and 2016, she said.

Mbombo further explained that patients requiring emergency treatment as a result of violent injuries often took preference, resulting in other patients waiting much longer for treatment, sometimes to the detriment of their health.

"This is a call to the public to consider these facts, especially how the personal choice to consume alcohol irresponsibly not only impacts the individual but robs other patients of much-needed medical attention," she said.

Nicol called for tighter regulation of firearms, saying even medics felt unsafe due to easy access to guns.

"It makes all of us feel very unsafe in society. We have to address the issue of firearm violence. We should be going for the route of a gun-free society. Firearms don't help people for protection. All they do is to allow people to be murdered easily."


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