For the doctors of the Western Command, the Kargil operation is an experience well-documented and test to learn a few more from.

This was the message gleaned from the Critical Care Update Symposium 3 and 4 yesterday, part of the Continuing Medical Education programme, held at the Command Hospital, Western Command. The Command Hospital played a crucial role in treating the casualties evacuated after initial treatment at forward medical establishments. "We have found that advancement in the field of surgical technique, availability of antibiotic and aggressive approach like soft tissue cover and primary fixation in open fracture after emergency repeated wound debridement found to be very satisfactory, but the rate and quality of union in these cases can only be commented after prolonged follow up," said Lt Col H.C. Talan, Department of Orthopaedics, Command Hospital (WC).

Typical of a bullet, mine or splinter wounds _ to the lower and upper limbs, the head and spinal cord _ were open wounds and broken or shattered bones. The jawan trying to climb up to the enemy bunkers also had to encounter rocks and boulders rolled down by them. Therefore, treating involved first treating open wounds against infection, then fixing up the damaged nerves, arteries, the tendons and the layers of skin. For those whose bones couldn't be treated internally, unique techniques like "nailing and screwing up" the were used. "...Eighty casualties required some form of reconstructive surgical intervention," says a document prepared by Col B.B. Dogra and Lt Col V. Bhatnagar, experts on reconstructive surgery.

According to them, the inference that can be drawn from the Kargil experience by the orthopaedics community is that thorough and meticulous debridement or cleaning up of the dead tissues reduces morbidity, correct fixation of hand bones can help `rework' them early, muscles can help fill cavities like that in a splinter wounds and that tissue cover speeds up recovery and encourages the patient's morale. Another interesting observation from the data collected by the Western Command is the fact that injuries pertaining to upper limbs was less (24.8 per cent) at the 1999 war theatre, as compared to 1971 (67 per cent). In other injuries also, that of the head, chest and abdomen, the injuries were less this year.

The Neurological Department at the Command Hospital treated 39 cases including head, spinal, neck and nerve injuries. According to Lt Col H.C. Pathak, apart from the bullets, mines and splinters, the jawans had to face the rocks and boulders. "There was no mortality in neurological cases." The department is halfway in completing the data as long-term follow up is required at this stage. Perhaps the worst challenge that the ENT department faced was from the splinters lodged in the injured jawan's face or nose. One patient had a shell splinter 1.2 cm x .8 cm (roughly the size of an index of a finger) lodged in the nose, said Lt Col K.B. Singh adding that it was removed endoscopically.

"It was only those patients who needed or prolonged treatment that were transferred here (at the Command Hospital). Closer to the war zone there were more cases who were treated there itself," Lt Col Singh said, adding that all the patients treated were fit to continue in the service. Though the net result is heartening, it's too early to say what the final documentation would be, as most of the patients are still on the road to recovery.