Management of gunshot injuries in children during armed conflicts

With the increasing number of military conflicts, acts of terrorism, and the use of modern weaponry, the problem of gunshot and mine-blast trauma (MBT) in children has acquired exceptional medical and social significance. Children constitute up to 20-50% of mass casualties victims, and the mortality rate for such injuries, according to various sources, reaches 57.1%. This review summarizes the keynote presentations of the symposium "Gunshot Wound," held as part of the XIII All-Russian Scientific and Practical Forum "Emergency Pediatric Surgery and Traumatology" (February 2025). Based on an analysis of the presented experience (including cases from Belgorod, Sevastopol, Moscow, and the Donetsk People's Republic), fundamental principles of providing care are identified. These include: a clear organization of staged medical evacuation based on effective triage of victims according to the «three streams» principle (red, yellow, green), and a presentation of the "golden hour" concept. A multidisciplinary approach, integrating the efforts of surgeons, traumatologists, ICU staff, psychologists, and rehabilitation specialists at all stages, is recognized as the cornerstone of the study. Particular attention is paid to combating wound infection, criticizing irrational antibiotic prevention and recommending the use of modern physical debridement methods, particularly low-temperature argon plasma, which demonstrates a pronounced antimicrobial effect and stimulates reparative processes. Early initiation of comprehensive physical and psychological rehabilitation to prevent contractures, chronic pain syndrome, and post-traumatic stress disorders is considered essential for a successful outcome. Thus, the problem requires a comprehensive multidisciplinary approach combining highly qualified surgical care with a well-established organizational system at all levels. The presented experience serves as the basis for the development of unified clinical guidelines aimed at increasing survival and improving the quality of life of children affected by military conflicts and emergency situations.

1. Goncharov S.F., Petlakh V.I., Rozinov V.M. Medical care for children affected by local military conflicts and terrorist attacks. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2015; 5(1): 21-27 (in Russ)

2. Dzheliev I.M., Yesenov K.T., Popovich V.S., Lolaeva B.M., Makoev V.O., Burnatseva M.M. Experience in the treatment of gunshot wounds to the chest in children. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2015; 5(1): 42-49 (in Russ)]

3. Khorram-Manesh A., Burkle F.M. Civilian Population Victimiza tion: a Systematic Review Comparing Humanitarian and Health Outcomes in Conventional and Hybrid Warfare. Disaster Med Public Health Prep. 2022; 17: e192. DOI: 10.1017/dmp.2022.96.

4. Burnett M. W., Spinella P. C., Azarow K. S., Callahan C. W. Pediatric care as part of the US Army medical mission in the global war on terrorism in Afghanistan and Iraq, December 2001 to December 2004. Pediatrics. 2008; 121(2): 261–265

5. Pearn J. Children and war. J. Paediatr. Child Health. 2003; 39: 166–172.

6. Budkevich L.I., Rozinov V.M. Tragedy in Bashkiria – the origins of the formation of modern pediatric combustiology in the service of disaster medicine. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2015; 5(1): 28-32 (in Russ)] DOI: 10.17816/psaic126

7. Dzheliev I.Sh., Popovich V.S., Lolaeva B.M., Yesenov K.T., Dzukaev A.I. Surgical tactics for gunshot wounds of the chest and abdomen in children. Rossijskij vestnik detskoj hirurgii, anesteziologii i reanimatologii. 2011; 1: 104-109 (in Russ)]

8. Maslyakov V.V., Dadaev A.Ya., Kerimov A.Z., Kurkin K.G. Immediate results of treatment of gunshot wounds of the chest in children. Novosti hirurgii. 2014; 22(3): 356-359 (in Russ)]

9. Hargrave JM, Pearce P, Mayhew ER, Bull A, Taylor S. Blast injuries in children: a mixed-methods narrative review. BMJ Paediatrics Open. 2019; 3: e000452. DOI: 10.1136/bmjpo-2019-000452

10. Tovar MA, Pilkington RA, Goodwin T, Root JM. Pediatric Blast Trauma: A Systematic Review and Meta-Analysis of Factors Associated with Mortality and Description of Injury Profiles. Prehosp Disaster Med. 2022; 37(4): 492-501. DOI: 10.1017/S1049023X22000747.

11. Michael DeCuypere, Michael S. Muhlbauer, Frederick A. Boop, Paul Klimo Jr. Pediatric intracranial gunshot wounds: the Memphis experience. J. Neurosurgery: Pediatrics. 2016; 17(5): 595–601

12. Zhang, J., Liu, Y., Zhao, Y., Deng T. Emergency evacuation problem for a multi-source and multi-destination transportation network: mathematical model and case study. Ann Oper Res. 2020; 291: 1153–1181. DOI: 10.1007/s10479-018-3102-x

13. Koryakovskii L.N., Artemyeva V.F., Khareva N.V. Medical triage in peacetime emergencies. Grazhdanskaya oborona i zashchita ot chrezvychajnyh situacii v uchrezhdeniyah, organizaciyah i na predpriyatiyah. 2016; 10: 51-65 (in Russ)]

14. Zorin V.I., Rybinskikh T.S. Medical care for children affected by armed conflicts. Medicina katastrof. 2023; 4: 33-41 (in Russ)] DOI: 10.33266/2070 1004-2023-4-33-41

15. Chevalley K, Zimmerman J, Mittendorf A, Sennersten F, Dalman A, Frogh S, Ringart T, Robinson Y, Sandström G. Civilian pattern of injuries in armed conflicts. Scand J Trauma Resusc Emerg Med. 2024; 32(1): 125. DOI: 10.1186/s13049-024-01299-7.

16. Medinsky P.V., Keshishian R.A., Nalbandian R.T., Useinov A.V. Errors and complications in wound treatment in children who suffered from an earthquake. Rossijskij vestnik perinatologii i pediatrii. 2025; 70(2/2): 82-89 (in Russ)] DOI: 10.21508/1027-4065-2025-70-2 (part 2)–82-89