British doctors are launching the world’s first handbook for child blast injuries designed for medics in war zones who often lack specialist training.
The Paediatric Blast Injury Field Manual is the first comprehensive guide to injuries suffered by children from weapons like airstrikes, artillery and landmines.
Writing for Sky News, former army doctor Paul Reavley, who now works as an NHS consultant for both adults and children in Bristol, explains the story behind the groundbreaking handbook.
In a war zone, medics are mentally prepared for adults. You expect to treat injured soldiers and even civilian adults.
But if you are a doctor who has never dealt with injured children, it is very daunting.
The sights and sounds of a young child torn apart by bombs is indescribable.
There is one case I will never forget. I remember having to resuscitate a young girl of around eight years old who had three limbs blown off by an improvised explosive device (IED).
She was about the same age as my own daughter, and even had the same hair colour.
I’m a trained paediatrician, but it hit me hard.
The instinctive connection to my life as a parent back home threw me off just when my mind needed to be at its clearest.
Seeing my military colleagues in Afghanistan and Iraq experiencing those emotions day after day is what drove me – together with a coalition of British doctors, experts and charities like Save the Children – to write the first manual for child blast injuries.
The handbook is a small, lightweight and durable field manual, covering the basics of saving a child’s life after they get hit by an airstrike, improvised device or explosive remnants of war.
The reality is that most medics know very little about how to treat children for extreme battle wounds, and they require different treatment than adults.
Most clinicians faced with these patients are not experienced in paediatric blast trauma. The textbooks and knowledge we already have are almost exclusively based on injured soldiers, which cannot be shrunk to fit a child.
It prepares doctors for dealing with the challenge of children injured by blasts and addresses both the physical and psychological needs of the child. It helps the doctor to better understand the child to better treat them.
But it is not just a handbook for practical procedures – it’s an emotional crutch to enable clinicians to do the best they can for the child at the time they most need it.
It illustrates that a lot of the skills they do have can be transferred to children with some simple key messages, empowering them to treat the child.
A growing child changes in size, they get different patterns of injuries and are more likely to be severely injured in a blast.
We also know that they have flexible bones and undeveloped muscles which offer less protection from blast – so their internal organs may well have ruptured, even if they lack a single visible wound.
When amputating a child’s limb, forgetting to factor in future growth could leave them with even worse disabilities or intractable pain for life.
The manual is illustrated with step-by-step instructions to avoid life-altering mistakes and provides medics with reassurance and guidance when an injured child arrives.
Any doctor working in conflict zones, military or civilian should be given access to further paediatric trauma training.
Doctors in Syria were among the first to request the manual to help then with the reality of their day to day work.
Research suggests that Syrian children were nearly seven times more likely to be killed by blasts in the first six years of the conflict than adults.
The manual will later be deployed to Afghanistan and Yemen. It is also available to download online for free.
This little book will save lives.