Two devastating events played a critical role in British scientists’ efforts to develop technology that could transform the treatment of people who suffer traumatic injuries in wars or disasters.
The first was the explosion that devastated Beirut on August 4, 2020, when a large stockpile of ammonium nitrate exploded in the city, killing more than 200 people and injuring 7,000. The second was Russia’s invasion of Ukraine, which has caused hundreds of thousands of casualties since war broke out there in February 2022.
“Both the Beirut blast and the fighting in Ukraine have caused thousands of horrific extremity injuries and crush injuries in people who would have lost legs and arms without urgent medical technology intervention,” said Anthony Bull, a professor of musculoskeletal mechanics at Imperial College in London.
“However, in the past, providing that expensive, complex intervention – during conflict or in the wake of natural disasters – has been a major problem.”
Prof Bull and his colleague Dr Mehdi Saeidi started a collaboration in 2016 that aimed to take a radical new approach to the problem – by finding simple ways to make complex medical devices to help those with catastrophic injuries caused by natural disasters or warfare. Instead of relying on devices flown in from developed countries, toolkits and manuals can be developed and distributed to local people so they can make their own devices in garages or factories using conventional equipment.
“We concentrated on devices known as external fixators,” Saeidi told the Observer. “It is used when a gunshot or a mine explosion or a collapsed building cuts off a person’s leg or arm bones. By holding pieces of shattered bone together, the injured person’s deep flesh wounds have a chance to heal and their limbs can be saved.
“It is very important that this is not done by inserting a metal rod into a limb, as this can cause serious infections. Instead, it is held outside and attached to the leg by pins that are pushed through a person’s arm or leg.”
However, external fixators are complex and expensive. A single device can cost more than £2,000 and in conflict zones they are difficult to access. Sometimes homemade fixators are made, but this often leads to serious complications.
To get around this problem, Bull and Saeidi launched their project with colleagues at Imperial and other international institutions, with funding from the National Institute for Health and Care Research and the Engineering and Physical Sciences Research Council.
“We designed simple ways to make external fixators and tested them in Sri Lanka,” Bull said. “It looked good. Then the Beirut explosion happened and there was an immediate call for hundreds of fixers to be sent there. We were not ready to help at this stage. Fortunately, other countries were able to step in and eventually send supplies. Nevertheless, it struck us that our initial idea was the right one.”
Since then, Bull and Saeidi have developed sets of instructions that can be used to produce fixators with limited skills and resources. “All it takes is a supply of aluminum and some stainless steel rods,” Saeidi said. “It’s very simple.”
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The value of this work was revealed in February 2022. After Russian troops poured across the border Ukrainehundreds of people suffered catastrophic injuries and faced losing limbs without fixators to save their arms and legs.
“We got an urgent call from local doctors who were desperate for help and we were able to direct them to our website, which has instructions on how to make fixators,” Bull said. A few days later, a workshop in Eastern Poland sent us a picture of a fixator they had just made from our instruction set. In the first few days of the war, 150 of them were deployed and would have helped prevent the injured from losing legs or arms.”
Since then, Saeidi has created a toolkit for making fixators and it is being tested in Kenya and Rwanda with the aim of perfecting a technology ready for use anywhere in the aftermath of earthquakes or wars.
“When you get events like Beirut or Ukraine, you get a sudden surge in horrific injuries,” Bull said. “We need simple ways to help doctors in these circumstances and that’s what our fixation kits need to do.”
