Mortality epidemiology in low-intensity warfare: Israel Defense Forces' experience

PURPOSE: an analysis of the mortality epidemiology in low-intensity warfare. BASIC PROCEDURES: we retrospectively reviewed all cases of Israeli soldiers killed in small-scale warfare during 1996-1998, using field data, hospital charts and autopsy reports. Data on injury pattern, offending munitions and time of death were analyzed. MAIN FINDINGS: in the study period, 106 soldiers were killed. Penetrating trauma was the common injury mechanism (95%) most frequently due to claymore bombs and gunshot bullets. The percentage dying in the prehospital phase and in the first 30-min were 77 and 88%, respectively. The average injury severity score (ISS) was 42.5. Seriously injured body regions were thorax (38%), head (24%), abdomen and pelvis (13%) and neck (12%). CONCLUSIONS: there is no trimodal death distribution in military trauma. Most casualties of low-scale conflicts die very early after injury. Most fatal injuries involve the head and trunk regions. The distribution of injury depends on the type of assaulting munitions.