A review of casualties during the Iraqi insurgency 2006–A British field hospital experience

doi:10.1016/j.injury.2008.03.028

Injury

Volume 40, Issue 5, May 2009, Pages 493-497

https://doi.org/10.1016/j.injury.2008.03.028 Get rights and content

Summary

Background

Following the invasion of Iraq in April 2003, British and coalition forces have been conducting counter-insurgency operations in the country. As this conflict has evolved from asymmetric warfare, the mechanism and spectrum of injury sustained through hostile action (HA) was investigated.

Method

Data was collected on all casualties of HA who presented to the British Military Field Hospital Shaibah (BMFHS) between January and October 2006. The mechanism of injury, anatomical distribution, ICD-9 diagnosis and initial discharge information was recorded for each patient in a trauma database.

Results

There were 104 HA casualties during the study period. 18 were killed in action (KIA, 21%). Of the remaining 86 surviving casualties, a further three died of their wounds (DOW, 3.5%). The mean number of diagnoses per survivor was 2.70, and the mean number of anatomical regions injured was 2.38. Wounds to the extremities accounted for 67.8% of all injuries, a percentage consistent with battlefield injuries sustained since World War II. Open wounds and fractures were the most common diagnosis (73.8%) amongst survivors of HA. Improvised explosive devices (IEDs) accounted for the most common cause of injury amongst casualties (54%).

Conclusions

Injuries in conflict produce a pattern of injury that is not seen in routine UK surgical practice. In an era of increasing surgical sub-specialisation, the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. IEDs have become the modus operandi for terrorists. In the current global security situation, these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of these injuries is relevant to both military and civilian surgeons.

Introduction

Following the invasion of Iraq in April 2003, British and coalition forces have remained in South Eastern Iraq as part of an UN mandated force to maintain security. Studies from the war-fighting phase of the early conflict showed a similar pattern of injury to the first Gulf War in 1991, despite changes in the mechanism of wounding.14, 9 With the evolution of the conflict from one of war fighting to a counter-insurgency operation, this study investigates the mechanism and spectrum of injuries caused by hostile action (HA).

The British Military Field Hospital, formerly located at Shaibah Logistics Base, was at the time the sole military hospital supporting Coalition forces in the British area of operations, treating both Coalition and, when need presented, Iraqi civilian casualties. In addition it provided a medical and surgical facility for the 7500 UK service personnel deployed in the area. It consisted of an emergency department, a 4-bedded intensive and high-dependency care unit, a 2-table operating theatre and 50 medium-dependency nursing beds in 3 tented wards. In addition radiological services with X-ray, ultrasound and CT, basic pathology and laboratory services supported the clinical effort. A transfusion capability of packed red cells and fresh frozen plasma was also available.

The clinical team consists of 1 general surgeon, 1 orthopaedic surgeon, 2 consultant anaesthetists, 1 consultant in emergency medicine and 1 consultant physician supported by a small staff of junior doctors, nurses and paramedics.

Casualties received initial treatment and resuscitation either at regimental aid posts or by the helicopter borne immediate medical response team. The majority of casualties were evacuated by helicopter and the remainder by wheeled vehicles.

Section snippets

Methods

All patients who presented to the hospital following injury from HA from January to October 2006 were included in this study. In addition data was collected on all coalition forces that were killed in action (KIA) during this study period. This cohort of patients forms the basis of this study.

Demographic information, mechanism of wounding, pattern of wounding, International Classification of Disease-9th edition (ICD-9) diagnosis,¹⁸ duration of any surgical procedures and initial discharge

Results

During the 9-month study period, 1746 patients were assessed at the hospital. Of these 86 were casualties from HA (4.9%). In addition, a further 18 coalition soldiers were KIA during the same period. Seventy-nine were coalition forces (69 UK, 7 Danish, and 3 US), 13 were non-Iraqi contractors and 12 were Iraqi nationals. The mean age of the casualties was 25.7 years (range 18–65).

The mechanism of injury is illustrated in Fig. 1: fragmentation weapons accounted for 76.1 % of casualties, gunshot

Discussion

From March 2003 till March 2007, 3494 Coalition troops have been killed in Iraq with a further 24,187 wounded in action.⁶ Only a small proportion of patients seen in our facility were injured from HA and our figure of 4.9% is comparable to the findings of previous conflicts.¹

The counter-insurgency operation has followed the usual pattern of this type of warfare but has been made especially difficult by the urban terrain. There is no frontline; the terrorists merging with the general population.

Conclusions

Injuries in conflict produce a pattern of injury that is not seen in routine UK surgical practice. In an era of increasing surgical sub-specialisation, the deployed surgeon needs to acquire and maintain a wide range of skills from a variety of surgical specialties. Use of IEDs has become more prevalent in current military operations. In the current global security situation, these tactics can be equally employed against civilian targets. Therefore, knowledge and training in the management of

Conflict of interest

None.

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A review of casualties during the Iraqi insurgency 2006–A British field hospital experience

Summary

Background

Method

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

Conflict of interest

Injury

Injury

A lesson not learned

J Royal Army Med Corps

Management of small fragment wounds: experience from the Afghan border

J Trauma

A military surgical team in Belfast

Ann R Coll Surg Engl

Analysis of wounds incurred by US Army Seventh Corps personnel treated in Corps hospitals during Operation Desert Storm, February 20 to March 10, 2001

J Trauma

Field hospital treatment of blast wounds of the musculo-skeletal system during the Yugoslav Civil War

J Orthop Trauma

Small fragment wounds: biophysics, pathophysiology and principles of management

J R Army Med Corps