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Table of Contents
LETTER TO EDITOR
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 84-85

Handling of surgical cases in a forward military location: Experience during the corona times


Department of Commandant & Surgical, Command Hospital, Northern Command, Udhampur, Jammu and Kashmir, India

Date of Submission26-Jun-2020
Date of Decision14-Aug-2020
Date of Acceptance03-Jul-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Dr. S C Gupta
Command Hospital, Northern Command, Udhampur, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJCS.IJCS_10_20

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How to cite this article:
Gupta S C, Sharma M. Handling of surgical cases in a forward military location: Experience during the corona times. Indian J Colo-Rectal Surg 2019;2:84-5

How to cite this URL:
Gupta S C, Sharma M. Handling of surgical cases in a forward military location: Experience during the corona times. Indian J Colo-Rectal Surg [serial online] 2019 [cited 2022 Sep 26];2:84-5. Available from: https://www.ijcrsonweb.org/text.asp?2019/2/3/84/295850

COVID-19 has changed the way we practice modern medicine forever, altering the basic tenets of touch, feel, and bond with patients. The practices of surgical specialties had to be changed like never before and triage has shifted from the battlefield and mass casualties practices to daily practice. Despite the primary responsibility of our hospital being to cater for the needs of operationally committed soldiers, we had to play a significant role in once in a lifetime crisis. A modus operandi to handle surgical cases was formulated.

  1. Core team: A core team was formulated to remain abreast of the abundant literature on COVID-19, which was shared with others on a daily basis
  2. Augmentation of infrastructure: Operational commitments remained unrelenting. Major changes in infrastructure were made to segregate routine cases from those suspected or confirmed of COVID-19


  3. (a)COVID surgical ward: All new surgical patients were admitted in a separate earmarked ward with mandatory physical distancing. With proper facilities for food distribution and linen collection

  4. Augmentation and training of workforce: workforce was augmented. Regular and periodic training of all available workforce was done
  5. Surgical grouping: Surgeons are precious commodities, and it can be catastrophic if the presence of one infected case leads to isolation/quarantine of the whole surgical setup of the hospital. Surgical teams were grouped and were forbidden to interact with each other or the same set of patients to form a barrier
  6. Common tenets for surgery:


    1. Surgeries were rationalized and limited
    2. All urgent surgeries were assessed to combat postoperative COVID19 infection
    3. Nonsurgical modalities where feasible were encouraged
    4. The hospital stay was reduced to the minimum possible
    5. Use of electronic media to reduce hospital visits


  7. Surgical triage:[1]


    1. Urgent surgeries: Only life and limb saving surgeries with complete personal protective equipment (PPE) were performed. The operation theater was thoroughly sanitized after the surgery as per the existing guidelines
    2. Nonurgent surgeries: Surgery was deferred till the time COVID status was ascertained. Preferably up to 7 days after hospitalization, these patients were closely watched for any change in condition
    3. Nonoperative treatments: Nonsurgical options were advised
    4. Elective surgeries: After evaluation of the risks of deferring these surgeries, they were delayed by a period of 3–6 months. Patients were properly counseled and procedures to return if need arises were established


  8. General instructions for surgery: Numerous guidelines have been offered for the performance of surgery with precautions for COVID-19.[1] Although each specialty has its own challenges but generally undermentioned are the important ones


    1. PPE was used suitably for both patients and doctors
    2. Patients were selected carefully
    3. Aerosol dispersal was minimized
    4. Use of low intra-abdominal pressures
    5. Using low-level electro-cautery was used with low burst time
    6. Pneumo-peritoneum was completely disinflated before trocar removal
    7. Bowel handling was minimized.


  9. For neurotrauma patients, guidelines issued by National Health Services (NHS) were adhered[2]
  10. Separation of these patients from other patients was ensured.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Al-Jabir A, Kerwan A, Nicola M, Alsafi Z, Khan M, Sohrabi C, et al. Impact of the coronavirus (COVID-19) pandemic on surgical practice-Part 2 (surgical prioritisation). Int J Surg 2020;79:233-48.  Back to cited text no. 1
    
2.
NHS England. Clinical Guide for the Management of Neurotrauma Patients during the Coronavirus Pandemic; 2020. Available from: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/specialty-guide-neuro-trauma-19-march-v2-updated.pdf. [Last accessed on 2020 Apr 02].  Back to cited text no. 2
    




 

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