Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan

Background

The North Atlantic Treaty Organization (NATO) coalition forces remain heavily committed on combat operations overseas. Understanding the prevalence and characteristics of battlefield injury of coalition partners is vital to combat casualty care performance improvement. The aim of this systematic review was to evaluate the prevalence and characteristics of battle casualties from NATO coalition partners in Iraq and Afghanistan. The primary outcome was mechanism of injury and the secondary outcome anatomical distribution of wounds.

Methods

This systematic review was performed based on all cohort studies concerning prevalence and characteristics of battlefield injury of coalition forces from Iraq and Afghanistan up to December 20th 2013. Studies were rated on the level of evidence provided according to criteria by the Centre for Evidence Based Medicine in Oxford. The methodological quality of observational comparative studies was assessed by the modified Newcastle-Ottawa Scale.

Results

Eight published articles, encompassing a total of n = 19,750 battle casualties, were systematically analyzed to achieve a summated outcome. There was heterogeneity among the included studies and there were major differences in inclusion and exclusion criteria regarding the target population among the included trials, introducing bias. The overall distribution in mechanism of injury was 18% gunshot wounds, 72% explosions and other 10%. The overall anatomical distribution of wounds was head and neck 31%, truncal 27%, extremity 39% and other 3%.

Conclusions

The mechanism of injury and anatomical distribution of wounds observed in the published articles by NATO coalition partners regarding Iraq and Afghanistan differ from previous campaigns. There was a significant increase in the use of explosive mechanisms and a significant increase in the head and neck region compared with previous wars.     

Lower limb injuries caused by improvised explosive devices: Proposed ‘Bastion classification’ and prospective validation

Background

Complex lower limb injury caused by improvised explosive devices (IEDs) has become the signature wounding pattern of the conflict in Afghanistan. Current classifications neither describe this injury pattern well, nor correlate with management. There is need for a new classification, to aid communication between clinicians, and help evaluate interventions and outcomes. We propose such a classification, and present the results of an initial prospective evaluation.

Patients and methods

The classification was developed by a panel of military surgeons whilst deployed to Camp Bastion, Afghanistan. Injuries were divided into five classes, by anatomic level. Segmental injuries were recognised as a distinct entity. Associated injuries to the intraperitoneal abdomen, genitalia and perineum, pelvic ring, and upper limbs, which impact on clinical management and resources, were also accounted for.

Results

Between 1 November 2010 and 20 February 2011, 179 IED-related lower limb injuries in 103 consecutive casualties were classified, and their subsequent vascular and musculoskeletal treatment recorded. 69% of the injuries were traumatic amputations, and the remainder segmental injuries. 49% of casualties suffered bilateral lower limb amputation. The most common injury was class 3 (involving proximal lower leg or thigh, permitting effective above-knee tourniquet application, 49%), but more proximal patterns (class 4 or 5, preventing effective tourniquet application) accounted for 18% of injuries. Eleven casualties had associated intraperitoneal abdominal injuries, 41 suffered genital or perineal injuries, 9 had pelvic ring fractures, and 66 had upper limb injuries. The classification was easy to apply and correlated with management.

Conclusions

The ‘Bastion classification’ is a pragmatic yet clinically relevant injury categorisation, which describes current injury patterns well, and should facilitate communication between clinicians, and the evaluation of interventions and outcomes. The validation cohort confirms that the injury burden from IEDs in the Helmand Province of Afghanistan remains high, with most casualties sustaining amputation through or above the knee. The rates of associated injury to the abdomen, perineum, pelvis and upper limbs are high. These findings have important implications for the training of military surgeons, staffing and resourcing of medical treatment facilities, to ensure an adequate skill mix to manage these complex and challenging injuries.     

某部驾驶训练士兵抑郁发生情况及心理训练的效果

目的：调查某部驾驶训练士兵抑郁发生情况,探讨心理训练对其的影响。方法某部384名士兵分为驾驶训练组176名,心理训练组164名,非驾驶训练组44名,采用Zung抑郁自评量表（ SDS）在训练前期、中期、后期对3组士兵进行测试,观察 SDS评分变化及抑郁发生情况。结果训练中、后期驾驶训练组 SDS评分高于非驾驶训练组和心理训练组（P〈0.05）。非驾驶训练组 SDS评分随训练时间延长而下降（P 〈0.05）;驾驶训练组训练中期 SDS 评分高于训练前期和训练后期（ P 〈0.05）,心理训练组 SDS 评分随训练时间延长而下降,训练后期下降更明显（ P 〈0.05）。结论驾驶训练可能是士兵抑郁发生的因素之一,心理训练有助于降低其抑郁水平。     

首次夏秋季入伍新兵情绪社交孤独感调查

目的了解首次夏秋季入伍新兵情绪社交孤独感的状况。方法应用情绪-社交孤独问卷(ESLI)和症状自评量表(SCL-90),对某部队2013年564名入伍新兵进行整群抽样测试研究,然后对其进行t检验和方差分析。结果①ESLI各因子与SCL-90各因子均存在显著性相关;②新兵SCL-90各因子得分均显著低于国内青年常模(t=9.48,8.5,15.39,14.88,8.57,11.94,8.59,13.96,6.90,6.96;P0.01)、军人新兵常模(t=19.53,14.29,19.07,19.89,18.14,13.13,21.72,23.68,23.91,13.11,21.47;P0.01);③不同性别的新兵孤独感各因子存在显著性差异(t=3.516,4.392,3.481,3.855;P0.01),是否独生子女对孤独感影响无显著性差异;④不同的文化程度对情绪孤立与社交孤立有显著性影响(F=3.746,6.241;P0.05),进一步多重比较表明,高中组新兵得分明显高于中专组;不同的文化程度对情绪孤独、社交孤独没有显著性影响。结论2013年入伍新兵的孤独感较低,心理健康状况较好;新兵的孤独感受性别、文化程度等因素的影响,男兵和高中文化的新兵更容易感受到孤独感。     

军事医学研究生创新能力各维度分析

目的探讨军事医学研究生创新能力在各个维度上的分布特征。方法以某军医大学研究生为例,应用威廉斯创造力倾向测量表,比较研究生总体、不同群体之间挑战性、好奇性、冒险性、想象力4个维度得分的差异。结果 1研究生创新能力各维度的得分有统计学差异(F=66.365,P=0.000),得分最高的是挑战性(75.566±10.316)和好奇性(75.012±10.807),其次是冒险性(72.839±10.070),最后是想象力(69.211±11.685);2不同群体研究生创新能力各个维度之间的比较,只有不同学历研究生在想象力方面有差异(F=4.381,P=0.037),博士研究生想象力(67.712±12.175)低于硕士研究生(69.643±11.500)。结论军事医学研究生创新能力的各个维度都在中上水平,挑战性和好奇性较高;不同群体之间的差别不大;相对而言,想象力匮乏,尤其是博士研究生。     

飞行人员心理旋转能力测验的练习效应

目的: 确定飞行人员在心理旋转能力测验中是否出现练习效应,并确定出消除心理旋转能力测验练习效应影响的最少练习遍数. 方法: 分别选择不同年龄段的飞行学员、飞行员、飞行教员77人,在指定时间段进行心理旋转测验,收集测验成绩的数据. 结果: ① 心理旋转测验中飞行学员、飞行员、飞行教员的正确反应率分别为98.7%, 96.4%, 93.6%;② 不同年龄阶段的飞行人员测验成绩的比较有显著差异(P<0.05);③ 飞行人员在测验中出现明显的练习效应,经LSD-t检验均达到显著水平(P<0.05). 结论: 练习效应是影响飞行人员心理旋转测验成绩变化的因素之一;为了消除正式测验时出现的练习效应而对测验成绩的影响,建议正式测验时的练习遍数不得少于12遍.     

军队士气理论研究综述

目的 通过对军队士气理论发展的回顾与评价,为军队的士气管理提供理论依据。方法 采用文献研究法。结果 国内外较．有影响的士气量表有3种,军队士气的主要维度包括：团体凝聚力、军事组织承诺和军事工作生活质量,士气对伤亡率、心理疾病的发生以及延长服役意愿都有较大影响。结论 国内对军队士气研究较少,需要加强对军队士气的理论和实证研究。     

医院信息系统与医保联网的问题与对策

医疗保险是国家医疗保险体制改革的重要举措,具有极其重要的意义,建立医保中心与医院信息系统（hospital information system,HIS）的联网,对于提高医保患者的结算效率与医保中心的管理能力,有着重要作用。但各医院在联网与实施过程中会有一些共性的问题,本文就这些问题,提出了对应的解决措施。     

Percutaneous dilatational tracheostomy for saturating influx of COVID-19 patients: Experience of military ENT physicians deployed in Mulhouse,France

ObjectivesThe main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination.Material and methodsA single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy.ResultsEighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7 minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage).ConclusionThis study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.