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28 May 2019

Doctors from UH Bristol contribute to world’s first handbook for child blast injuries

Doctors from University Hospitals Bristol NHS Foundation Trust, alongside colleagues from the Paediatric Blast Injury Partnership (PBIP) have written and launched a life-saving handbook for children severely injured by explosive weapons.

The Paediatric Blast Injury Field Manual was developed by the PBIP, a coalition of doctors and experts founded by Save the Children and Imperial College London, and is designed for medics in war zones who often lack specialist training. It is the first comprehensive guide to injuries suffered by children from weapons like airstrikes, artillery and landmines.

Earlier this month Save the Children partner Syria Relief began distributing the manual for the first time to emergency units across northwest Syria, including Idlib and Aleppo. The guide will be deployed later in the year to other conflict zones including Yemen and Afghanistan, and is also freely available to download via the Save the Children website.

Dr Paul Reavley, a former UK military doctor and now a consultant emergency physician for both adults and children at UH Bristol, was the lead author on the project.  Paul worked with UH Bristol colleagues Dan Magnus, clinical lead and consultant in paediatric emergency medicine, and Andy Lockyer, consultant in emergency medicine, on the handbook, which includes step by step instructions covering a wide range of scenarios, from resuscitating children on the battlefield and saving limbs, to rehabilitation and psychological care.

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Paul recently met with Syrian clinicians in Turkey to understand their challenges and to help improve the care to those affected and injured in the ongoing conflict. Speaking about the importance of the handbook, Paul said:

"I've seen medics overcome with emotion when children come in with blast wounds. In a war zone, you're mentally prepared for the adults. You expect to treat injured soldiers, and even civilian adults. But the sights and sounds of a young child torn apart by bombs are something else. 

"I remember in Afghanistan having to resuscitate an 8-year-old girl, who had three limbs blown off by an improvised explosive device (IED). She was about the same age as my own daughter. I'm a trained paediatrician, but that connection shook me hard. And it hits you just when your mind needs to be at its clearest. 

"Until this manual, there really hasn't been anything to prepare doctors for dealing with the horror of children injured by blasts. For the first time it tackles psychological, as well as the physical, challenges. It's not just a guide to practical procedures - it's a crucial emotional crutch."

Speaking about UH Bristol's role in global health, Dan said:
"As a consultant in the children's emergency department here in Bristol I know how privileged we are to be able to provide world class emergency care for children and the safety and quality of care for the children and families of Bristol and the south west is our primary concern.

"However, we also have a responsibility to help to improve child health globally too. Working with Paul, who led this project, and other UH Bristol colleagues to support medical staff looking after children in incredibly difficult circumstances in Syria has been a humbling experience. It is an important reminder of how amazing our staff are here at UH Bristol and what an important contribution our children's hospital has to make in a global context."

Andy added:
"This is an incredible achievement for the team to have created something that is so accessible and intuitive to help save children's lives around the world. It addresses every aspect of the care of the child, and will make a huge difference. We have a moral responsibility as  doctors to engage global healthcare issues, and to provide support where we can."

Most medical studies are based on injured military personnel, making definitive estimates for the scale of blast injury in children almost impossible. But existing research, while limited, suggests children suffer unique patterns of injury and are far more likely to die from blast wounds than adult conflict casualties.

Major General Michael von Bertele CB OBE FRCP, former Director General of British Army Medical Services and a member of Paediatric Blast Injury Partnership (PBIP), said:
"The sad reality is most medics just haven't been trained to treat children injured by blasts. Nearly all the textbooks and procedures we have are based on research on injured soldiers, who are usually fit adults. 

"We know children's bodies are different. They aren't just small adults. Their skulls are still not fully formed, and their undeveloped muscles offer less protection, so a blast is more likely to damage their brain and lungs or tear apart organs in their abdomen, even when there's no visible damage.

"And when children suffer severe injuries to their legs and arms, it takes highly specialised knowledge to know where to amputate so that you can factor in future growth. Without that, children are left with even worse disabilities, and often intractable pain for life."


Notes to editors:

Media contact: Matt Thackray: 01173423629