Gunshot Wound to the Extremities - 511

On the contrary of stab wounds, gunshot bullet trajectories, and injuries are difficult to predict. Improper evaluation of the damages and surgical errors are typical. Our initiative will help medical students quickly learn the ballistics and the pathophysiology of the extremities' firearm injuries to properly evaluate vascular damages. The trainees will learn vascular anastomosis and shunt insertion skills using two interactive web applications training modules: 
i) a 3D ballistic trauma simulation for thorough wound assessment of vascular lesions, with predictions of potential vascular damages through the determination of bullet trajectory and knowledge of ballistic trauma.
ii) Virtually mimicking vascular surgery using two monitors: one showing a video of a real surgery that plays and pauses intermittently, and another monitor on which the trainee simulate the expected sequence that is paused, by using special remote control that mimic surgical tools. The simulated surgery will be checked/verified when the video resumes.

We will teach introductory ballistic trauma courses for fast diagnostic of vascular damages in the limbs caused by a firearm. The training modules are as follow:

• A 3-D virtual exploration and assessment of vessel lesions sustained from gun bullets and blasts. The virtual simulator is a demo of ballistic trauma scenarios to help trainees perform a thorough evaluation of vascular damages and anticipate corrective measures.  
• The trainee will virtually mimic vascular anastomosis and shunts insertion, using monitors, video of real surgery and step-by-step guidance (play-pause-mimic-check) for real-time self-learning and self-evaluation. The trainee watches on one monitor a footage of lesions repairs. Sequentially, the video pauses at regular intervals, during which the trainee uses a second monitor and special remote controls as mock surgical tools to simulate/anticipate the following steps on the paused surgery video. Specifically, the trainee will mimic the specific gestures/procedures (expected to happen on the video) including incisions, aligning tips of vessels, repositioning parts of vessels, insertion of shunts etc. When the video resumes, the trainee checks and learn about the correct and detailed surgical procedures.  

Our training course is an online open-source platform with real surgery videos, algorithms, decision trees, and quizzes, available in multiple languages.

We aim to teach modules that are specific to extremities gunshot wounds. The modules are as follow:

• Ballistics and pathophysiology of gunshot-wound trauma. The ballistic trauma learning allows trainees to be skilled in a rapid and thorough assessment of firearm gunshot/blast and explosive injuries, bullet trajectories, and potential damages to internal organs
• Prediction of vascular damages through the determination of a bullet trajectory allows a description of potential and specific impacts on blood vessels, muscles, ligaments, and tissues.
• Vascular anastomosis 
• Restoration of blood perfusion through the insertion of vascular shunts
• Utilization of appropriate instruments, equipment, and suture materials
• Indication for bullet removal.

In 2019, 51,154 firearm and explosion victims were recorded in the Sahelian region in West Africa due to terrorism activities and insecurity. There are few specialized trauma and orthopedic surgeons in the area. It is critical to building capacity for rapid and proper evaluation and management of firearm injuries, especially vascular damages, which can be life-threatening or lead to catastrophic consequences, including amputations. Our real-time self-learning training module will assist medical students, and novice surgeons to quickly learn and master best practices of vascular repairs.

Health practitioners in developing countries often lack life-saving skills and surgical technical capacity specific to gunshot injuries. We aim to train young medical doctors who want to learn fast, essential firearm injuries, trauma evaluation and management, and vascular surgery. The training program will target medical practitioners, including medical students, non-surgeon doctors, and novice surgeons. Potential trainees will undergo phone screening, interviews, and baseline needs assessments, including pre-tests on necessary surgical skills before entering the program. It is a 6-month on-the-job-training in which the trainees enrolled in the program remain on their post. Our self-learning web application includes the following: 1) learning ballistic trauma and predicting vascular lesions using a 3-D virtual simulator, 2) mimicking hemorrhage control, especially vascular anastomosis and insertion of shunts, using video-assistance and a drawing board with mock surgical tools. The online platform includes a built-in monitoring system to evaluate performance, including recording failed and successful trainee attempts. It will also offer a tutorial and an option to liaise with and get advice from a surgery instructor. A final evaluation will provide an opportunity for comments and to assess the level of satisfaction.

Achille Kabore MD, Medical Doctor

Thierry Sarr MSc, and social entrepreneur 

Luwedde Aliba, MD PhD. Surgery assistant professor. Education specialist

Looking for a 3-D simulation designer and developer
A software engineer to develop and connect a special drawing board to a monitor playing slow-motion videos
We are also looking for a ballistic trauma instructor -preferably a military surgeon