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Water jet injury care needs to improve

16 July 2019

MEDICAL RESEARCH commissioned by the Water Jetting Association has led to the publication of the most comprehensive guidance ever created for the treatment of high-pressure fluid injection injuries.

The guidance is set to transform the emergency medical response to water jet injuries, greatly reducing the risk of death, long-term disability or unnecessarily prolonged periods of recovery.

David Kennedy, director of the Water Jetting Association (WJA), which funded the research, said, “This represents a step change in our understanding of how to treat high-pressure fluid injection injuries.

“Employers, first responders, paramedics and hospital medical teams have, for the first time, clear guidelines on the optimum treatment protocols for patients from first-line response through to definitive hospital care.

“Since the research paper detailing the findings has been published, it has been downloaded hundreds of times around the world, is already likely to be having an impact on how patients are treated.

“The new set of ‘Water Jetting Injury Management Guidelines’ allow us to update the medical advice in our Codes of Practice. We’ll do all we can to share these guidelines with stakeholders who can help improve emergency treatment and the survivability of operatives in our industry should a serious incident occur.”

The research paper – Management of industrial high-pressure fluid injection injuries (HPFII): the Water Jetting Association (WJA) experience with water-driven injuries European Journal of Trauma and Emergency Surgery.

Its authors are: Intensive Care Consultant Dr Sancho Rodriguez-Villar of Kings College Hospital, London; Dr Robert Kennedy PhD, the WJA’s Clinical Research and Development Advisor, who is a trained researcher and a former NHS Ambulance Service First Responder and who played a pivotal role in bringing the research team together; Consultant Trauma and Acute Care Surgeon Mr Carlos Pilasi Menichetti, also from Kings College Hospital, London; and Consultant Microbiologist Dr Martino Dall’Antonia, from Queen Elizabeth Hospital (Woolwich), London.

The study found that the unique nature of HPFII injuries makes them look less serious than they are. This often leads to delays in patients receiving the appropriate emergency treatment, often with serious long-term consequences.

Dr Sancho Rodriguez-Villar said, “The evidence shows that, without early and correct intervention, the outcome for those injured is often catastrophic, including death, loss of limbs and long-term disability.

“Following this research, we strongly advise all parties involved to observe the WJA’s newly updated guidelines for the management of high-pressure injection injuries.”

The two main and most common injuries that occur during water jetting are trauma caused by an uncontrolled hose striking the body or by the puncturing of the skin by a jet of fluid under pressure, known as hydraulic fluid injection.

Hydraulic fluid injection can occur at pressures as low as 40 bar, or 580 pounds per square inch (psi), far lower than the pressure achieved by many over-the-counter water jetting machines. Ultra-high-pressure water jetting can exceed 2,500 bar, or 36,259 psi.

Water jet injuries commonly have very small entrance wounds and no exit wounds, which can mask the seriousness of the “extensive disruption” of deeper tissues that can be caused, said the researchers.

Debris and bacteria can be also carried far into the body by the jet of fluid, increasing the risk of serious infection and other problems that need to be considered carefully as part of emergency treatment programmes.

The researchers said, “High pressure water jet injuries should always, without exception, be considered contaminated wounds and treated as surgical emergencies.”

This should include a period of medical observation. However, the researchers observed: “Even though many members of the WJA carry a medical card alerting the medical staff of the potential injuries, in many cases, patients are discharged home from the emergency department without even an observation period.”

The study concluded: “A lack of comprehension of the potential severity of injuries is still the main obstacle to early and effective treatment. This appears largely due to the initial apparently minor nature of the presentation of an injury that can, unfortunately, have catastrophic consequences, such as amputation or death.”