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ASEAN REGIONAL FORUM

ASEAN REGIONAL FORUM. ANTI PERSONNEL MINES Assistance to Victims Lt Col (Dr) Muhamad Fuad Daud B.Sc(Med) MD(UKM) M.Surg(Ortho) MALAYSIA. Introduction. Cruelest Ever Man made Design Medical, Social and Economic Consequences Causing Morbidity and Mortality Aim

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ASEAN REGIONAL FORUM

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  1. ASEAN REGIONAL FORUM ANTI PERSONNEL MINES Assistance to Victims Lt Col (Dr) Muhamad Fuad Daud B.Sc(Med) MD(UKM) M.Surg(Ortho) MALAYSIA

  2. Introduction • Cruelest Ever Man made Design • Medical, Social and Economic Consequences • Causing Morbidity and Mortality • Aim • To maime - as an injured soldier takes up far more resources than a deceased soldier during a conflict • To kill

  3. Introduction • Problem – it is not selective - Children, Elderly • Animals

  4. Mechanism of Injuries • Depends on type of APM • Blast • Projectile metal (Shrapnel) • Involve any part of bodies • Usually lower limb • Dies due to massive bleeding or direct injuries to vital organs

  5. Most Commonly Observed Patterns of Injuries • Pattern 1: caused by a blast mine, results in the foot or leg being blown away (traumatic amputation), with varying degrees of injury to the other leg, genitalia, arms or chest. Very few survive blast mines with a larger explosive charge.

  6. Most Commonly Observed Patterns of Injuries • Pattern 2: caused by a fragmentation mine, or wounds similar to those caused by other fragmentation devices (grenades, mortar shells, etc); can affect any part of the body.

  7. Most Commonly Observed Patterns of Injuries • Pattern 3: caused by accidental detonation whilst handling a mine, results in severe wounds on the hands, arms and face and, in some cases, blindness

  8. Assistance to Victims and Survivors • The Ottawa Treaty requires: “Each State Party in a position to do so shall provide assistance for the care and rehabilitation, and social and economic reintegration, of mine victims and for mine awareness programs.”

  9. Management • Long Duration • Continous Process • From initial injury until pt independant • Involve Multidiscipline (Team Based Approach) • Surgeons/Psychologist/Religious Officer/Rehab Specialist • Rewarding

  10. Objectives • To treat the injuries and prevent further complication • To assist in psychological and physical recovery • To achieve functional and independent person • To provide skill development and initial financial support

  11. How? 3 Main Components: • Surgery - Initial • Psychology - Throughout • Rehabilitation- Last Phase

  12. How? Surgery • Surgery • Initial Trauma • Transport to nearest medical facilities • Amputation/Reconstructive Surgery • To minimize injuries and maximise functional limb

  13. Surgery • Limb usually severed / functionless • End with Amputation

  14. Surgery

  15. How? Psychology • Exposure to traumatic event • Psychological Trauma • Worst in children • Treatment involved victim and family • Psycologist (Child) • Religious Office

  16. Psychology • Psychological first aid • Needs assessment • Monitoring the recovery environment • Outreach or information dissemination • Technical assistant, consultation and training • Fostering resilience • Coping and recovery • Triage and treatment

  17. Psychology

  18. How? Rehabilitation • A branch of medicine dealing with restoration of function despite physical disability • Aim: • Assisting in ambulation • Application of Orthosis or Prosthesis • Acquiring special skills (Pt able to be independent)

  19. Rehabilitation • Pre Operative • Post Operative • Pre Prosthetic Stage • Prosthetic Stage

  20. Rehabilitation – Pre Operative • Physical Assessment • Muscle Strength, • Joint Mobility, • Respiratory Function, • Improve balance, • restore functional independence and • treat phantom limb • Social Assessment • Family & friends Support • Living Accomodation • Psychological Assessment • Pt’s approach to amputation and the motivation to walk

  21. Rehabilitation – Post Operative • Pre Prosthetic • Management of Stump • Maintain Strength • Restore Functional Independence • Prevention of Post Op Complication • Prevention of Deformity

  22. Rehabilitation – Post Operative • Prosthetic • Assessment • Age/Physical • Mental Condition • State of Stump • Level of Amputation • Prosthetic • Temporary • Definitive

  23. Prosthetic • Artificial substitute for a missing part of the body • Replacement of Limbs • Upper Limb • Lower Limb

  24. Malaysia Experience • Insurgencies in 1960-90 • Usage of IED by CPM soldiers • Causing lot of Casualties among security forces • Most – Lower Limb Injuries • Amputated

  25. What we’ve done • Initial Treatment • Started on Rehab with Psychological Assistance • Remained working and productive • Retiree supported by Veteran Affairs Dept • Compensated • Prostetic/Orthotic Replacement

  26. Conclusion • Effects of APM is devastating and involve not only adults but children as well • Management depends on problems arises and involve multidiscipline • Requires support from government /NGO • Benefit to patient, families and country.

  27. What can we offer? • Training for Surgeons, Psychologist, Occupational Therapist, Rehab Specialist and Orthotic/Prosthetic Personnels • Advice and assistance in setting Post Trauma Center – One stop Center

  28. Thank You

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