MedicalResearch.com Interview with:
Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS
Professor – Department of Surgery
London Health Sciences Centre
London, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was performed by medical and nursing officers who were all deployed to the war zone. We were deeply concerned about the type of injuries we were seeing. They were more awful than any we had seen before. We were familiar with reviews of antipersonnel landmine injuries that were reported by Red Cross surgeons in the 1990s. The injuries that we were dealing with were from antipersonnel IEDs more than landmines. We decided to do a formal prospective study for two reasons: first was to carefully describe the pattern of injury so we could develop new medical strategies, if possible, to help victims. The second reason was to catalogue these injuries so we could impartially and scientifically report what we were witnessing.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: The study confirmed our worst fears. The injuries caused by antipersonnel IEDs are far, far worse than those we have seen with antipersonnel landmines. That is not to say that the injuries caused by landmines are not terrible but the IED is an order of magnitude worse. We believe that our study shows that the antipersonnel IED appears to be designed to cause “superfluous injury and unnecessary suffering”.
MedicalResearch.com: What do you mean by “superfluous injury and unnecessary suffering”?
Response: The antipersonnel landmine or IED has the military purpose of denying ground such as pathways to an adversary by injuring a soldier and requiring his or her medical team to be deployed. The injuries caused by the IED are far in access of this purpose. The antipersonnel IED mutilates the victim, who may not have been a soldier at all, leaving them with life-long disabilities and ongoing suffering. The soldiers who go out every day facing this threat are heroes beyond imagination. The victims must be cared for, medically and financially, for the rest of their lives.
MedicalResearch.com: But “superfluous injury and unnecessary suffering” sounds like an official term?
Response: The injuries are obviously superfluous and instigating life long suffering is cruel and unnecessary. The term however is the medical component of the definition of a war crime.
MedicalResearch.com: Are you saying that using antipersonnel IEDs is a war crime?
Response: We are medical officers. We are not lawyers. What we saw and described are injuries consistent with war crimes. To determine if the other components of war crimes were present is up to other authorities.
However we have now prospectively described injures from this weapon to be superfluous to military purpose and the cause of unnecessary suffering. I would say that if antipersonnel IEDs are deployed with that purpose in future the conditions for a war crime would have been met.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: A great deal of work has been done by others to develop immediate care strategies that reduces haemorrhage and preserve limbs and tissue. Innovations in personal protective equipment will reduce the magnitude of the injury. In the end however we need a campaign to stop use of antipersonnel IEDs just like the successful campaign of the 1990s reduced the use of antipersonnel landmines.
MedicalResearch.com: You are currently deployed?
Response: Yes, but I would rather not discuss it too much. This work is about the patients, civilian and military, and about the people who have to go about their lives fearful that their next step will result in the worst injuries ever described in conflict.
MedicalResearch.com: What is your name and details?
Response: I am Lieutenant Colonel Vivian McAlister of the Royal Canadian Medical Service. I am a general surgeon who works in Canada.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Shane Smith, Melissa Devine, Joseph Taddeo, Vivian Charles McAlister. Injury profile suffered by targets of antipersonnel improvised explosive devices: prospective cohort study. BMJ Open, 2017; 7 (7): e014697 DOI: 10.1136/bmjopen-2016-014697
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