Sri Lanka

Abstract

Sri Lanka is an island in the Indian Ocean. In 1983, there was a civil war between the government forces and separatists that lasted for 26 years. During the war, combatants and, to a lesser degree, civilians in the conflict zone sustained injuries due to high-velocity gunshots, mortars, and bomb blasts. Surgeons had a daunting task managing these patients in addition to injuries sustained by civilians in other parts of the country. The sheer number and frequency of gunshot injuries in both combatants and civilians, and the often-delayed nature of their presentation, were the key challenges of this experience. The strategy adopted to surmount these issues was to build a hybrid system of care, harnessing both military and civilian medical resources and infrastructure facilities at the border of the conflict zone. These medical facilities were established at varying distances away from the war zone and were equipped and staffed to care for casualties of increasing complexity, with the initial assessment of limb viability performed using the time-honored method of clinical assessment. Resuscitation and attempt at bleeding arrest were performed employing improvised techniques. Restoration of blood supply was prioritized over management of skeletal and soft tissue injuries. Ten years after the war, there is a paradigm shift in the wound profiles and the challenges faced by trauma and vascular surgeons in Sri Lanka. Various strategies are being employed by civilian and military authorities to mitigate these problems.