Wartime burn care in Iraq: 28th Combat Support Hospital, 2003

INTRODUCTION: The U.S. Army 28th Combat Support Hospital (CSH), an echelon III facility, deployed to Iraq at the start of military operations in 2003. Shortly after arrival, it was designated as the hospital primarily responsible for burn care for the U.S. military in Iraq. This report reviews the experience of the CSH with burn care during combat operations. METHODS: An after-action review was conducted during a 2-day period after the hospital's redeployment. RESULTS: Between April 11, 2003, and August 21, 2003, the 28th CSH treated a total of 7,920 patients, of whom 103 (1.3%) had burns. Patients included U.S. and allied service members, U.S. contractors, and Iraqi prisoners of war and civilians. Although a CSH is designed to care for patients until they can be stabilized and evacuated, usually within 1 to 3 days, the length of stay for some Iraqi patients was as long as 53 days. Definitive care, including excision and grafting of the burn wound, was thus required for some Iraqi patients. The largest graft completed comprised 40% of the total body surface area. The largest burn survived involved approximately 65% of the total body surface area. Eighteen (17%) of 103 patients returned to duty after treatment at the 28th CSH. The mortality rate for burn patients at the 28th CSH was 8%. Shortages of burn-experienced personnel and burn-specific supplies were identified during the after-action review. CONCLUSIONS: The CSH provided complex definitive care to burn patients in an austere environment. Predeployment identification of military field hospitals for such specialized missions, with early assignment of experienced personnel and materiel to these units, may improve future wartime burn care.     

The experience of the intensive care unit in a British Army field hospital during the 2003 Gulf conflict

Over the last few years the Surgeon General's Department has overseen a major update in equipment scales for medical units in the field; anaesthesia and intensive care. This is to meet the aspiration of the Defence Chiefs, that injured servicemen on active service should receive the same standard of care as available in the United Kingdom. This paper discusses the experiences of the Intensive Care Unit operating within a Field Hospital both during the initial war fighting phase and subsequent peace keeping phase of the 2003 Gulf conflict (OP TELIC). Observations are made on patient activity, treatment strategy, and equipment adequacy.     

Land mine injuries: a study of 708 victims in North Iraq and Cambodia

OBJECTIVE: The aim of this study was to explore the effect of low-cost prehospital trauma systems on trauma outcome in land mine victims and to study prehospital risk indicators for better triage of land mine injuries. METHODS: A 5-year prospective study of the effect of in-field advanced life support provided by local paramedics was conducted in mine-infested areas in North Iraq and Cambodia. RESULTS: After implementation of a rural rescue system, there was a significant reduction in trauma mortality from 26.2% in 1997 to 11.8% in 2001 (95% confidence interval for difference, 5.1%-23.6%). The mortality rate was significantly higher in fragmentation mine victims, 25.2%, as compared with blast mine victims, 5.7% (95% confidence interval for difference, 14.4%-24.6%). The severity of associated fragment injuries in patients with traumatic amputations is a solid risk predictor (area under the curve in receiver operating characteristics plots > 0.9). CONCLUSIONS: Low-cost prehospital trauma systems improve trauma outcome in land mine victims where prehospital transit times are high. The fragment wounds represent the main challenge for trauma care providers.     

Land mine injuries in the northernmost border of Greece: our experience at the University Hospital of Alexandroupolis during 1991-2003

We studied the mortality and morbidity caused by land mine injuries in 169 cases that presented at the University General Hospital of Thrace, Alexandroupolis, Greece, during the period of 1991 to 2003. The data analyzed included the emergency room records, the admission records, and the autopsy records from the coroner that provided information on cause of death either in the prehospital phase, the initial treatment, or during the period following definitive surgical repair. Eleven percent of the casualties were lethally injured, the majority of whom died before reaching the hospital. Twenty-eight percent suffered severe injuries that required hospitalization and surgical management, placing an organizational and financial strain upon the hospital's resources, and 40% bore light injuries requiring only ambulatory treatment in the emergency room.     

With war in mind: a dialogical analysis of the mindset underlying Blair's case for war with Iraq in 2003

Dialogical Analysis, a tool from Cognitive Analytic Therapy, is used to discover how the mindset of war silences dialogue. The savage costs of war were hidden whilst the United Kingdom government expected to attract the admiration of a grateful world. This article looks at an example of this mindset expressed through Tony Blair MP's speech to the House of Commons on 18 March 2003. The speech aimed at convincing parliament that war was inevitable, necessary and the only obvious choice. It offered an extremely narrow presentation of options available to the government, in which 'staying firm' was coupled with the case for war whilst alternative, peaceful methods of conflict resolution were identified as 'weak and feeble' and viewed as encouraging terrorists.     

高原颌面部雷管爆炸伤3例

通过对3例高原地区颌面部雷管爆炸伤救治病例分析,建议对高原环境下颌面部爆炸伤救治中及早吸氧并行气管切开术;只要伤口无明显感染症状,在彻底清创,严密缝合口内伤口的前提下,伤后48～72小时进行Ⅰ期清创缝合和骨折内固定术是可行的。     

Cold injuries among Israeli soldiers operating and training in a semiarid zone: a 10-year review

Cold weather injuries (CIs) in 242 incidences among Israeli soldiers, who were operating and training in a relatively warm country, were reviewed. Peripheral CIs accounted for 55% of all CIs, whereas hypothermia accounted for 45%. A significant relationship was found between peripheral CIs and continuous operations, characterized by prolonged static exposures to a relatively high environmental cold stress. A significant relationship was also found between hypothermia cases and training activities, characterized by relatively short exposures to a low environmental cold stress in the absence of adequate protective clothing for the cold. Static exposure to a cold environment while wearing wet clothing was found to be the leading cause of both CI types. Peripheral CI prevention requires the improvement of protective clothing for the cold, with special emphasis on protective gear for the extremities. Hypothermia prevention requires increased awareness of military regulations regarding cold weather behavior, especially the importance of changing wet clothing during static periods of the training program.     

Experience in organizing the surgical work of a garrison hospital in an armed conflict

The authors have summarized organizational experience of surgical work of garrison military hospital strengthened with specialized brigades during the period of armed conflict in Republic of Dagestan (August-September, 1999). From the start of active actions in order to render assistance specialized surgical teams from district military hospital equipped with special kits (at the rate of 7 operations/day during a week) were sent to garrison hospital. In this armed conflict there are features characterising both mine-and-explosive war in Afghanistan and sniper war in Chechen Republic resulting in increase in the number of seriously wounded (up to 46.7%) casualties during Botlikhski? operation constituted 1:4, Novolakski? (Kadarski?)--1:5. Bullet injuries were fatal in 49.4% of the cases, fragmentation (including MET)--50.6%. During 1.5 month of hospital work there were performed 303 surgical interventions. 22.7% of slightly wounded from local garrisons were treated in garrison hospitals. Treatment results--postoperative lethality in gunshot trauma at the given stage constituted 1.1%.     

Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II

Improvised explosive devices and mines pose a formidable threat to military convoys traveling in Iraq. This study evaluated battle injuries sustained by a mechanized battalion operating against this threat. The objective was to gain insight into injury profiles and prevention. In the period examined, 32 attacks injured 120 Marines, causing 188 injuries. Upper extremity and head injuries (70%) were common, whereas lower extremity injuries (11%) were rare (as expected, given the threat and the body areas exposed). Shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat. Ear injury was the most common single injury type (23%). Combat earplugs may reduce ear blast injuries. Eye injuries were uncommon (0.5%), likely because of ballistic eye protection. Injury to the torso (11%) was generally mild, because of body armor vests. The majority of wounds were minor, allowing > 80% of the injured Marines to return to duty.     

Potential applications of hyaluronans in orthopaedics: degenerative joint disease, surgical recovery, trauma and sports injuries

The use of hyaluronans for the treatment of pain in patients with osteoarthritis of the knee is well established. There are growing data to suggest that they may also alter the rate of disease progression. Reviewed here are preliminary data that also indicate a potential use for hyaluronans in the treatment of inflammatory arthropathies (e.g. acute joint trauma and fractures) that require long periods of immobilisation, and in tissue engineering for chondral defects. Although the trials that have investigated the use of hyaluronan therapy for the management of traumatic and degenerative musculoskeletal disorders seen in sports medicine have limitations in design and patient number, the results have been promising and suggest that larger controlled clinical trials are warranted.     

Trauma readiness training for military deployment: a comparison between a U.S. trauma center and an Air Force Theater Hospital in Balad, Iraq

The U.S. Air Force created the Center for Sustainment of Trauma and Readiness Skills at the Shock Trauma Center (STC) where staffs rotate before deployment. We sought to investigate the value of this training. A retrospective review of prospectively collected data of patient volume, injury severity, mechanism of injury, operative cases, and massive transfusion data from September 2006 to August 2007 was obtained from the STC in Baltimore and the Air Force Theater Hospital (AFTH) in Balad. Severity of injury and massive transfusions were higher at the AFTH. Soft tissue wound care represented approximately 25% of AFTH cases; a soft tissue service performed 465 operative debridements for severe soft tissue infections at STC. The STC's high-volume of major soft tissue debridement cases may offer the closest approximation of high energy wound care. Training at selected U.S. trauma centers may prepare military staff to care for war injuries, particularly those who do not practice in high-volume Level 1 trauma centers.     

A humanitarian mission in southern Iraq: utilization of the 7th Field Hospital of the Army of the Czech Republic--a report on its medical activities and working conditions

Between April 24 and September 18, 2003, a total of 7,099 outpatient treatments were performed. Between June 3 and September 18, 2003, a total of 124 patients were surgically treated and 209 patients were hospitalized; the hospital recorded 1,239 bed-days, 137 of them in the intensive care unit. A total of 924 X-ray and ultrasound examinations were performed, as well as 10,014 laboratory tests. Local inhabitants accounted for 90.5% of the patients. In their practice, the doctors encountered a very wide spectrum of surgical and nonsurgical diagnoses. Part of the work was to support humanitarian activities, with supplies of humanitarian material, selection of children for specialized cardiosurgical treatment in the Czech Republic, and blood donations. Work in that unstable region was significantly complicated by the extreme climate and the high security risk.     

With war in mind: A dialogical analysis of the mindset underlying Blair's case for war with Iraq in 2003

Dialogical Analysis, a tool from Cognitive Analytic Therapy, is used to discover how the mindset of war silences dialogue. The savage costs of war were hidden whilst the United Kingdom government expected to attract the admiration of a grateful world. This article looks at an example of this mindset expressed through Tony Blair MP's speech to the House of Commons on 18 March 2003. The speech aimed at convincing parliament that war was inevitable, necessary and the only obvious choice. It offered an extremely narrow presentation of options available to the government, in which ‘staying firm’ was coupled with the case for war whilst alternative, peaceful methods of conflict resolution were identified as ‘weak and feeble’ and viewed as encouraging terrorists.     

Cervical injuries during high G maneuvers: a review of Naval Safety Center data, 1980-1990.

As aircraft capable of sustaining high "G" maneuvers enter the U.S. Navy Fleet, the reported incidence of cervical injury to aircrew seems to have increased. To determine the extent of the problem, personal injury reports submitted to the Naval Safety Center were reviewed for the 10-year period from 1980 to 1990. In addition, confidential questionnaires were sent to flight surgeons supporting fighter/or fighter-attack units. The data collected were statistically analyzed. The incidence of cervical injuries, defined as at least one day's absence from the flight schedule, was computed. Other subjective factors, such as the type helmet worn, the cockpit position flown and the type of mission profile completed, were examined. As might be expected, the most common offender was air combat maneuvering. The most common aircraft was the F/A18, but the radar intercept officer position in the F14B was also a significant contributor. The most common injury pattern reported was a simple muscle strain. Cervical pain after high "G" missions poses a potential threat to combat readiness. However, the use of the newer lightweight helmet seems to have reduced the severity. Muscle strengthening exercises appear to help in prevention. Treatment is successful in most cases with minimal or no residuals noted. As yet, there exist little official data to support the notion of a major problem.     

Initial evaluation of posterior cruciate ligament injuries: history, physical examination, imaging studies, surgical and nonsurgical indications

Compared with anterior cruciate ligament injuries, posterior cruciate ligament injuries are a rare event. The mechanisms are predictable and a thorough physical examination is mandatory to rule out or define combined injury patterns. Stress radiography and magnetic resonance imaging studies are very helpful adjuncts. Acute and chronic injuries require slightly different approaches. As our understanding of normal and pathologic knee joint kinematics develops, nonoperative rehabilitation goals and operative techniques continue to evolve.     

The pattern of homicidal slash/chop injuries: a 10 year retrospective study in University Hospital Kuala Lumpur

Homicides as a result of slash/chop injuries are not commonly reported in forensic literature. A 10 year retrospective study from 1987 to 1996 was performed on the pattern of homicidal slash/chop injuries in University Hospital, Kuala Lumpur. A total of 37 cases were analysed. The ages ranged from 17 to 85 years. The victims consisted of Indonesian (37.8%), Chinese (27.0%), Indian (24.3%) and Malay (8.1%) ethnic groups; 2.7% of the cases were not identified. Most of the cases were due to intentional violence (n = 27), while the rest consisted of domestic violence (n = 2), robbery (n = 2), psychiatric homicide (n = 1), accident (n = 2) and unclassified (n = 3). In the intentional violence group, the majority of the victims (n = 16) had more than five wounds. In contrast, the victims in other categories had less than five wounds each, with the exception of a single case in the psychiatric-homicide group. In homicide victims with a single wound, the most common site of injury was the neck. In those with multiple wounds, the common sites were the head and neck. Sixteen cases showed defence injuries, all of them belonging to the intentional-violence group. The reasons for the high incidence of homicidal slash/chop wounds are discussed, as well as the difficulties associated with interpretation of such wounds.     

Social and hygienic characteristic of servicemen of peace making forces in a zone of Georgian and Abkhazian armed conflict

To improve the social-and-hygienic status of the staff in the zone of Gergian-and-Abkhazian armed conflict the following measures are suggested. To send the servicemen to the zone of armed conflict only according to the contract for the period not more than 6 months with 10-day leave granted in 3 months; to conduct the careful professional and moral-and-psychological selection. Before the mission to sign the additional contract with the servicemen explaining the service conditions in peacemaking forces. To conduct the military medical examination and consider whether the health status allows to stay in the region. Prophylaxis of oral cavity and chronic diseases. To give the servicemen their medical records; to strengthen the propaganda of healthy way of life and sports; to increase the financial allowance; to improve the conditions of placing and rear provision.     

Incidence, causes, and severity of high school football injuries on FieldTurf versus natural grass: a 5-year prospective study

BACKGROUND: Numerous injuries have been attributed to playing on artificial turf. Recently, FieldTurf was developed to duplicate the playing characteristics of natural grass. No long-term study has been conducted comparing game-related, high school football injuries between the 2 playing surfaces. HYPOTHESIS: High school athletes would not experience any difference in the incidence, causes, and severity of game-related injuries between FieldTurf and natural grass. STUDY DESIGN: Prospective cohort study. METHODS: A total of 8 high schools were evaluated over 5 competitive seasons for injury incidence, injury category, time of injury, injury time loss, player position, injury mechanism, primary type of injury, grade and anatomical location of injury, type of tissue injured, head and knee trauma, and environmental factors. RESULTS: Findings per 10 team games indicated total injury incidence rates of 15.2 (95% confidence interval, 13.7-16.4) versus 13.9 (95% confidence interval, 11.9-15.6). Minor injury incidence rates of 12.1 (95% confidence interval, 10.5-13.6) versus 10.7 (95% confidence interval, 8.7-12.7), substantial injury incidence rates of 1.9 (95% confidence interval, 1.4-2.6) versus 1.3 (95% confidence interval, 0.8-2.1), and severe injury incidence rates of 1.1 (95% confidence interval, 0.7-1.7) versus 1.9 (95% confidence interval 1.2-2.8) were documented on FieldTurf versus natural grass, respectively. Multivariate analyses indicated significant playing surface effects by injury time loss, injury mechanism, anatomical location of injury, and type of tissue injured. Higher incidences of 0-day time loss injuries, noncontact injuries, surface/epidermal injuries, muscle-related trauma, and injuries during higher temperatures were reported on FieldTurf. Higher incidences of 1- to 2-day time loss injuries, 22+ days time loss injuries, head and neural trauma, and ligament injuries were reported on natural grass. CONCLUSIONS: Although similarities existed between FieldTurf and natural grass over a 5-year period of competitive play, both surfaces also exhibited unique injury patterns that warrant further investigation.