Between April 1975 and November 1976, 8,324 casualties came though the Emergency Room of AUB (Table 21.1). The age range was newborn to 76 years but most were adult males 14–30 years; only 20 % were >30 years and 10 % <14 years. Gender differences were males 87 %, and females 13 %. Shrapnel was the cause of injury in 66 %, bullet wounds in 29 %, and blast injuries and extensive burns in 5 % [2]. Abdominal injuries were most common at 35 %, followed by chest 21 %, extremities 20 %, head 13 %, spine 2 %, mandible 1 %, and multiple injuries 8 % (Table 21.2).

Patients dead on arrival at the Emergency Room had usually succumbed immediately from overwhelming injury or from exsanguination (Fig. 21.2a–c) Death from trauma occurs in a trimodal fashion. Fifty percent of deaths in the theater of war are immediate and result from massive injury to a major vessel, the heart, the brain, or the spinal cord. After a hiatus period, sometimes called the “golden hour,” 30 % of deaths occur as a result of potentially treatable conditions such as hypoventilation, hemorrhage, hemopneumothorax, cardiac tamponade, or an expanding intracranial mass. Days to weeks later, 20 % of patients die from sepsis or multiple-organ failure, or both.

Triage in the emergency room (Fig. 21.3) consisted of assigning patients to one of the three categories:

Table 21.3 illustrates some of our challenges. Unprepared for such a massive onslaught personnel were afraid. Also, given the large exodus of many who were able to leave Lebanon, we were short not just of supplies but also of skilled people.

Oxygen and nitrous oxide were in shortest supply. We economized gas by using low flows via a carbon dioxide absorption circuit. All respirators driven by oxygen (Ohio, Bird, etc.) were retired. Finally we used compressors to feed room air into anesthesia machines. The noise of these machines compelled us to turn to simple draw over equipment such as the Epstein, Mackintosh, and Oxford (EMO) inhaler (Fig. 21.4a, b).

As many as 150 casualties might come in simultaneously and we had to transfer more severely injured cases to the recovery room where they were assessed, resuscitated and triaged further (Fig. 21.5). Cardiac tamponade and major vessel injuries were given first priority. Life-threatening trauma cases were transferred directly to the operating room which was in close proximity to the recovery room. Table 21.4 lists our assessment.