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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


To maime - as an injured soldier takes
up far more resources than a deceased
soldier during a conflict
To kill
Introduction
Problem
– it is not selective
- Children, Elderly
- Animals

Mechanism of Injuries

Depends on type of APM



Involve any part of bodies


Blast
Projectile metal (Shrapnel)
Usually lower limb
Dies due to massive bleeding or
direct injuries to vital organs
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.
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.
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
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.”
Management


Long Duration
Continous Process


Involve Multidiscipline (Team Based
Approach)


From initial injury until pt independant
Surgeons/Psychologist/Religious
Officer/Rehab Specialist
Rewarding
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
How?
3 Main Components:
Surgery - Initial
 Psychology - Throughout
 Rehabilitation- Last Phase

How?

Surgery
Surgery



Initial Trauma
Transport to nearest medical facilities
Amputation/Reconstructive Surgery

To minimize injuries and maximise
functional limb
Surgery


Limb usually
severed /
functionless
End with
Amputation
Surgery
How?


Exposure to
traumatic event
Psychological
Trauma


Worst in children
Treatment
involved victim
and family


Psycologist (Child)
Religious Office
Psychology
Psychology




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
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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
Psychology
Stages
Stage 1
(less than
4 weeks
after
trauma)
Diagnosis
Acute
Stress
Disorder
Assessment Use
Acute Stress
Disorder Interview
Beck Depression
Inventory
Beck Anxiety
Inventory
Stage 2
(if
symptom
present
within 3
months)
Post
Traumatic
Stress
Disorder
Beck Depression
Inventory
Beck Anxiety
Inventory
Treatment
1. Cognitive Behavioral Therapy
a. Education about trauma
reaction.
b. Progressive muscle relaxation
training.
c. Imagined exposure to
traumatic
memories.
d. Cognitive restructuring.
2. Supportive counseling
1. Cognitive Behavioral Therapy
a. Learning skills for coping with
anxiety, managing anger,
preparing for stress reaction.
2. Antidepressants medications.
3. Psychological Interventions.
a. Individual psychological
interventions
b. Group psychological
interventions.
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)

Rehabilitation


Pre Operative
Post Operative


Pre Prosthetic Stage
Prosthetic Stage
Rehabilitation – Pre Operative

Physical Assessment
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Social Assessment
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Muscle Strength,
Joint Mobility,
Respiratory Function,
Improve balance,
restore functional independence and
treat phantom limb
Family & friends Support
Living Accomodation
Psychological Assessment

Pt’s approach to amputation and the
motivation to walk
Rehabilitation – Post Operative

Pre Prosthetic


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Management of
Stump
Maintain Strength
Restore Functional
Independence
Prevention of Post
Op Complication
Prevention of
Deformity
Rehabilitation – Post Operative

Prosthetic


Assessment
 Age/Physical
 Mental Condition
 State of Stump
 Level of
Amputation
Prosthetic
 Temporary
 Definitive
Prosthetic
Artificial substitute
for a missing part of
the body
Replacement of
Limbs
•Upper Limb
•Lower Limb
Malaysia Experience





Insurgencies in 1960-90
Usage of IED by CPM soldiers
Causing lot of Casualties among
security forces
Most – Lower Limb Injuries
Amputated
What we’ve done


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Initial Treatment
Started on Rehab with Psychological
Assistance
Remained working and productive
Retiree supported by Veteran Affairs
Dept


Compensated
Prostetic/Orthotic Replacement
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.
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
Thank You