Nature of Casualties Changed in Iraq Following Invasion

Marine forward surgical units see patients with more injuries, more fragment wounds during insurgency than during original invasion

WEDNESDAY, June 18 (HealthDay News) -- The types of casualties that the U.S. Marine Corps Forward Resuscitative Surgery System units in Iraq have treated have evolved since the invasion of Iraq due to factors including improvised explosive devices and longer transport times, according to research published in the June issue of the Archives of Surgery.

Stacy A. Brethauer, M.D., of the Cleveland Clinic in Ohio, and colleagues compared factors related to 338 casualties treated by the surgical units during the invasion in March and April 2003 (Operation Iraqi Freedom I, or OIF I) and 895 casualties treated between March 2004 and February 2005 (OIF II).

The later phase was marked by a higher number of major injuries per patient (2.4 in OIF II versus 1.6 in OIF I), with more casualties with fragment wounds and a trend toward fewer gunshot wounds. In the first phase, 40 percent of casualties treated at the units were Iraqi, which dropped to 23 percent during the second phase. For critical U.S. casualties, the median time to presentation increased from 30 minutes in OIF I to 59 minutes in OIF II.

"We…maintain that the corpsman, medic and general medical officer treating casualties on the battlefield need clear guidance regarding which patients should be evacuated directly to surgical care. A theater-wide trauma system should provide this guidance with simple protocols. We propose that all casualties requiring litter transport be evacuated directly to surgical care. Only immediate lifesaving measures should be performed in the field (intubation, needle thoracostomy, tourniquets) and rapid transportation to surgical care should be obtained," the authors write.

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