Royal College Of Surgeons.docx

A surgeon overseeing the response to the Christchurch mosque attack has shared the horrific details of victims injuries. Laura Walters was at the Select Committee hearing when Dr James McKay explained the lifelong damage the fragmenting bullets did to the bodies and minds of the victims. When Canterbury surgeon James McKay listed the injuries of those brough to Christchurch Hospital following the Christchurch mosque attacks last month, the room went silent. MPs closed their eyes and shook their heads, as the most sobering submission of the day was laid out before those tasked with changing the country’s gun laws in an effort to keep New Zealanders safer. The Royal Australiasian College of Surgeons spoke of the damage done by guns and referred to these laws as a public health issue. They described the lifelong diabilities and impacts on shooting victims. McKay also told the committee the gunman used fragmenting bullets, which did significant damage when they entered the body. The Christchurch Hospital trauma specialist was the oncall general surgeon on March 15. He was in charge of triaging the cases flying through the doors and later performed multiple operations on victims. In less than an hour, the hospital received 48 critically injured patients with penetrating injuries from high-velocity projectile weapons. McKay said the Christchurch Hospital team was used to dealing with penetration wounds from knives or sharp objects, not from military-style semi-automatic weapons. The primary goal of using a gun to shoot someone was to kill, “or at very least injure tissue as much as possible”, McKay told the Finance and Expenditure Select Committee on Thursday. He spoke of the nature of the injuries and the “grossly contaminated wounds”. Then went on to list the wounds seen on March 15, and the medical response, in what was a striking reminder of the damage done by a single gunman, with a modified weapon. “There were significant chest, lung and major blood vessel injuries, which required emergency lifesaving surgeries, often multiple times in multiple patients,” McKay said. “Multiple abdominal injuries with injuries to bowel and stomach, resulting in significant contamination of all body cavities and wounds. This results in sepsis or infection and necessitated more multiple operations to drain and wash these out. The fractures associated with the gunshot wounds were often open and in pieces, which required significant orthopedic fixation and years of therapy.

Some patients had significant damage to major nerve bundals and their spinal cords were affected. Some of these wounds would take long and complex reconstruction, and some would result in permanent disability, he said. Other skin and tissue wounds would require further reconstructive surgery or skin grafts. These types of injuries could consign victims to a lifetime of disability physically, mentally and emotionally. “Physical disabilities can be devastating for the patient, their livlihood and their family.” Mentally, the victims would have the constant struggles of dealing with, and in many instances reliving, the personal psychoactive trauma they had experienced, McKay said. “This has been patently eveident in the large number of victims we still have in hospital from the March 15 attacks.” McKay explained how the fragmenting bullets used by the terrorist on March 15 did significant damage to tissue. While some bullets would fragment when they hit bone, there were some injuries where no bone was involved but the bullets had fragmented. The college’s executive director of surgical affairs Richard Lander said the college advocated for a full firearms register, which included all acquisitions, transfers and thefts to individuals and organisations. Lander also called for measures that would tighten the vetting process, in order to stop people from doing harm to themselves or others. Part of these measures should include more stringent checks of an applicant’s online activity, and the police ability to access ta person’s medical records. McKay and Lander said as well as the current legislation before the Select Committee, anything that could be done, must be done to reduce the risks of people gaining access to weapons and doing harm to others and themselves. As well as the victims, the shootings had an impact on staff responding to the attack, McKay said. There were hundreds of staff involved in the response, and 15-20 general surgeons. With multiple people still in hospital there had been effects on staff, including emotional impacts and fatigue. Health Minister David Clark said the health system had responded very well in the circumstances.

The health system stood ready to help victims with healthcare, as well as physical and psycho-social support in the future. The Finance and Expenditure Select Committee heard oral submissions throughout the day on Thursday, as the law which will ban military-style semi-automatic weapons and assault rifles is rushed through the legislative process. The Arms (Prohibited Firearms, Magazines, and Parts) Amendment Bill was introduced to the House on Tuesday, when it passed its first reading, before being passed to select committee. The bill is expected to pass its third reading on, or before, April 11, with almost unanimous support.

NOTES: Penetrating injuries, from what looked like high-velocity projectile weapons. Usually deal with knives and sharp objects. Injuries from gunshots are extremely high-energy and carry with them significant force... the primary goal is to kill and at very least injure tissue as much as possible. The injuries were grossly contaminated wounds and manes wound irrigation. Remove foreign material with multiple operations. The dead tissue result – this worsens when use bullets that fragment on impact. It appears these bullets have been used. Cause maximum tissue injury – acts of March 15. Part of the acts of March 15. Don’t want to dwell on individual parients - privacy There were signifdicant chest, lung and major blood vessel injuries, which required emergency lifesaving surgeries, often multiple times in multiple patients. Multiple abdominal injuries with injuries to bowel and stomach, resulting in significant contamination of all body cavities and wounds, this results in sepsis or infection and necessitated more multiple operations to drain and wash these out. Fractures associated are often open and in pieces, which requirtes significant orthopedic fixation and years of therapy. Nerve injuries are difficult to identify, but some patients have damage to major bnerve bundals and affected spinal cord. These take long, and complex reconstruction and some will result in multiple of significant permanent disability. Skin is often narcrotic and result in significant tissue loss and can result in further disability or need for further reconstructive surgery or skin grafts.

Overall high-calibre?? gunshot injuries can consign victims to a liufetime of disability, both physically as touched on, but also mentally and emotionally. Physical disabilities can be devastating for the patient, their livlihood and their family. Mentally they’ll have the constant struggles of dealing with, and in many instances reliving the personal psychoactive trauma they have experienced. This has been patently eveident in the large number of victims we still have in hospital form the march 15 attacks. Anything that can be done, must be done to reduce the risks of people gaining access to and doing harm to others and themselves. As well as legislative measures.mental health services. Issue reduction of gun violenec and glorification in media. Fragmenting: There are different types. Some will fragment rather than pass through tisse. Some will hit bone and fragment. Some injuries where there are no bones and the bullet has fragmented. More psych services both for patients. Health services: There werev hundreds of staff involved. 15-20 general surgeons. DHB and external services have been supportive. With multiple people still in hospital there has been effects on staff, emotional and in terms of fatiguq. Rosters and time off. The health system has responded, in my view, very well in the circumstances. Visited the surgeons and met the paramedics who went into the mosque. I’m also aware that some of these people have had multiple surgeries already. Stands ready to support these people as best they can I’m aware that canterbury hasd taken steps to ensure less urgent care is put – p[rioritise. Make The college’s executive director of surgical affairs Richard Lander said XXXX