Two shattering events played a key role in British scientists' efforts to develop technology that could transform the treatment of people suffering traumatic injuries in wars or disasters.
The first bombing to devastate Beirut was on 4 August 2020, when a large store of ammonium nitrate exploded in the city, killing more than 200 and injuring 7,000. The second is Russia's invasion of Ukraine, which has claimed hundreds of thousands of lives since the outbreak of war in February 2022.
“Both the Beirut bombings and the wars in Ukraine have resulted in thousands of horrific limb injuries and crush injuries, with people losing legs and arms without emergency medical technology intervention,” said Anthony Bull, professor of musculoskeletal mechanics. Imperial College London.
“In the past, that expensive, complicated intervention — during conflict or natural disasters — was a big problem.”
Professor Bull and his colleague Dr Mehdi Saidi started a collaboration in 2016 with the aim of taking a radical new approach to the problem – finding simple ways to create complex medical devices to help victims of natural disasters or catastrophic injuries from war. Instead of relying on devices flown in from developed countries, kits and manuals can be developed and distributed to local people so that they can build their own devices in garages or factories using conventional equipment.
“We focused on devices called external fixators,” Saidi said the observer. “These are used when a person's legs or arms are severed by gunfire or a mine explosion or a collapsed building. By holding the broken bone fragments together, the injured person's deep flesh wounds have a chance to heal and their limbs can be saved.
“Importantly, this is not done by inserting a metal rod into a joint, as this can trigger serious infections. Instead, it is attached to the bone with pins that are placed outside and pushed through a person's arm or leg.
However, external adjustment is complicated and expensive. A device costs more than £2,000 and access to them is difficult in conflict zones. Sometimes fixators are made at home, but they often lead to serious complications.
To tackle this problem, Bull and Saidi started their project with colleagues at Imperial and other international institutions, with funding from the National Institute for Health and Care Research and the Engineering and Physical Sciences Research Council.
“We designed simple ways to make external fixators and tested them in Sri Lanka,” Bull said. “It was great. Then there was the Beirut explosion and there was an immediate call to send hundreds of fixers there. We are not ready to help at this point. Fortunately, other countries were able to step in and eventually send goods. Nevertheless, it struck me that our initial idea was correct.
Since then, Bull and Saidi have developed methods that can be used to prepare fixators with limited skills and resources. “All that's needed is aluminum and some stainless steel wire,” said Saidi. “It's very straightforward.”
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The value of this work was revealed in February 2022. Hundreds of people suffered catastrophic injuries and lost limbs without fixators to save their arms and legs after Russian troops crossed the border into Ukraine.
“We got an emergency call from local doctors who were desperate for help and were able to point them to our website with instructions on how to fix them,” Bull said. “Two days later, a workshop in eastern Poland sent us a photo of a fixator they had made from our instruction kit. In the first few days of the war, 150 of them were recruited and helped prevent the wounded from losing legs or arms.
Since then, Saeidi has developed a toolkit for making the fixators, and these are being tested in Kenya and Rwanda, with the aim of developing a ready-to-use technology anywhere in the wake of earthquakes or wars.
“When you get events like Beirut or Ukraine, you get a sudden surge in horrific injuries,” Bull said. “We need simple ways to help doctors in these situations, and that's what our fixator kits should do.”
