Skip to main content
Top
Published in: World Journal of Surgery 10/2014

01-10-2014

Impact of Explosive Devices in Modern Armed Conflicts: In-Depth Analysis of Dutch Battle Casualties in Southern Afghanistan

Authors: Rigo Hoencamp, Eelco P. Huizinga, Thijs T. C. F. van Dongen, Floris J. Idenburg, Arul Ramasamy, Luke P. H. Leenen, Jaap F. Hamming

Published in: World Journal of Surgery | Issue 10/2014

Login to get access

Abstract

Background

The patterns and mechanisms of injuries of all Dutch battle casualties (BCs) were analyzed to improve the care for injured service members. We performed an in-depth analysis of all Dutch BCs during the participation of The Netherlands as lead nation in the International Security Assistance Force mission in southern Afghanistan.

Methods

Participants were selected from the trauma registry at the Dutch Role 2 Medical Treatment Facility if they met the criteria for Dutch BC between August 2006 and August 2010.

Results

The trauma registry query resulted in 199 Dutch BCs. The battle injuries were predominantly caused by explosions (83.9 %). The case-fatality rate was 9.5 %: 16.5 % were killed in action, and 1.1 % died of wounds. The wounding pattern was as follows: head and neck (32.2 %), thorax (7.8 %), abdomen (12.7 %), upper extremity (17.6 %), lower extremity (29.7 %). The mean Abbreviated Injury Scale and Injury Severity Score were 3 (range 0–5) and 11 (range 1–43), respectively in the wounded-in-action group.

Conclusions

Explosive devices accounted for almost 85 % of the casualties—much higher than in previous wars. Knowledge of the management of these injuries is also valuable in treating casualties from natural disasters or (terrorist) mass casualty situations. An integral multinational joint approach is highly recommended to develop more effective protective equipment and body armor. Prospective registration in a standardized system of data collection that encompasses all echelons of the medical support organization should be implemented.
Literature
1.
go back to reference Hoencamp R, Idenburg FJ, Hamming JF et al (2014) Incidence and epidemiology of casualties treated from August 2006 to August 2010 at the Dutch role 2E at multi national base Tarin Kowt Afghanistan. World J Surg. doi:10.1007/s00268-014-2462-x Hoencamp R, Idenburg FJ, Hamming JF et al (2014) Incidence and epidemiology of casualties treated from August 2006 to August 2010 at the Dutch role 2E at multi national base Tarin Kowt Afghanistan. World J Surg. doi:10.​1007/​s00268-014-2462-x
3.
go back to reference Ramasamy A, Harrisson S, Lasrado I et al (2009) A review of casualties during the Iraqi insurgency 2006: a British field hospital experience. Injury 40:493–497PubMedCrossRef Ramasamy A, Harrisson S, Lasrado I et al (2009) A review of casualties during the Iraqi insurgency 2006: a British field hospital experience. Injury 40:493–497PubMedCrossRef
4.
go back to reference Belmont PJ Jr, McCriskin BJ, Sieg RN et al (2012) Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma 73:3–12CrossRef Belmont PJ Jr, McCriskin BJ, Sieg RN et al (2012) Combat wounds in Iraq and Afghanistan from 2005 to 2009. J Trauma 73:3–12CrossRef
5.
go back to reference Owens BD, Kragh JF Jr, Wenke JC et al (2008) Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 64:295–299PubMedCrossRef Owens BD, Kragh JF Jr, Wenke JC et al (2008) Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma 64:295–299PubMedCrossRef
6.
go back to reference Belmont PJ, Goodman GP, Zacchilli M et al (2010) Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a US Army brigade combat team. J Trauma 68:204–210PubMedCrossRef Belmont PJ, Goodman GP, Zacchilli M et al (2010) Incidence and epidemiology of combat injuries sustained during “the surge” portion of operation Iraqi Freedom by a US Army brigade combat team. J Trauma 68:204–210PubMedCrossRef
7.
go back to reference Gawande A (2004) Casualties of war: military care for the wounded from Iraq and Afghanistan. N Engl J Med 351:2471–2475PubMedCrossRef Gawande A (2004) Casualties of war: military care for the wounded from Iraq and Afghanistan. N Engl J Med 351:2471–2475PubMedCrossRef
9.
go back to reference Hoencamp R, Idenburg FJ, Vermetten HGJM et al (2014) Lessons learned from the Dutch deployed surgeons and anaesthesiologists to Afghanistan: February 2006–November 2010. Mil Med (in press) Hoencamp R, Idenburg FJ, Vermetten HGJM et al (2014) Lessons learned from the Dutch deployed surgeons and anaesthesiologists to Afghanistan: February 2006–November 2010. Mil Med (in press)
11.
go back to reference Therien SP, Nesbitt ME, Duran-Stanton AM et al (2011) Prehospital medical documentation in the Joint Theater Trauma Registry: a retrospective study. J Trauma 71:S103–S108PubMedCrossRef Therien SP, Nesbitt ME, Duran-Stanton AM et al (2011) Prehospital medical documentation in the Joint Theater Trauma Registry: a retrospective study. J Trauma 71:S103–S108PubMedCrossRef
12.
go back to reference Holcomb JB, Stansbury LG, Champion HR et al (2006) Understanding combat casualty care statistics. J Trauma 60:397–401PubMedCrossRef Holcomb JB, Stansbury LG, Champion HR et al (2006) Understanding combat casualty care statistics. J Trauma 60:397–401PubMedCrossRef
13.
go back to reference American Association for Automotive Medicine (1985) The abbreviated injury scale (AIS)—1985 revision. American Association for Automotive Medicine, Des Plaines, p 60018 American Association for Automotive Medicine (1985) The abbreviated injury scale (AIS)—1985 revision. American Association for Automotive Medicine, Des Plaines, p 60018
14.
go back to reference Baker SP, O’Neill B, Haddon W Jr et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMedCrossRef Baker SP, O’Neill B, Haddon W Jr et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196PubMedCrossRef
15.
go back to reference Navarro SR, Abadia de Barbara AH, Gutierrez OC et al (2012) Gunshot and improvised explosive casualties: a report from the Spanish Role 2 medical facility in Herat, Afghanistan. Mil Med 177:326–332CrossRef Navarro SR, Abadia de Barbara AH, Gutierrez OC et al (2012) Gunshot and improvised explosive casualties: a report from the Spanish Role 2 medical facility in Herat, Afghanistan. Mil Med 177:326–332CrossRef
16.
go back to reference Patel TH, Wenner KA, Price SA et al (2004) A U.S. Army Forward Surgical Team’s experience in operation Iraqi Freedom. J Trauma 57:201–207PubMedCrossRef Patel TH, Wenner KA, Price SA et al (2004) A U.S. Army Forward Surgical Team’s experience in operation Iraqi Freedom. J Trauma 57:201–207PubMedCrossRef
17.
go back to reference Ramasamy A, Harrisson SE, Clasper JC et al (2008) Injuries from roadside improvised explosive devices. J Trauma 65:910–914PubMedCrossRef Ramasamy A, Harrisson SE, Clasper JC et al (2008) Injuries from roadside improvised explosive devices. J Trauma 65:910–914PubMedCrossRef
18.
go back to reference Ramasamy A, Masouros SP, Newell N et al (2011) In-vehicle extremity injuries from improvised explosive devices: current and future foci. Philos Trans R Soc Lond B 366:160–170CrossRef Ramasamy A, Masouros SP, Newell N et al (2011) In-vehicle extremity injuries from improvised explosive devices: current and future foci. Philos Trans R Soc Lond B 366:160–170CrossRef
19.
20.
go back to reference Cooper GJ, Maynard RL, Cross NL et al (1983) Casualties from terrorist bombings. J Trauma 23:955–967PubMedCrossRef Cooper GJ, Maynard RL, Cross NL et al (1983) Casualties from terrorist bombings. J Trauma 23:955–967PubMedCrossRef
21.
go back to reference Mellor SG, Cooper GJ (1989) Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–84: the Hostile Action Casualty System. Br J Surg 76:1006–1010PubMedCrossRef Mellor SG, Cooper GJ (1989) Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–84: the Hostile Action Casualty System. Br J Surg 76:1006–1010PubMedCrossRef
22.
go back to reference Bellamy RF, Zajtchuk R (1991) Assessing the effectiveness of conventional weapons. Textbook of military medicine. Part I. Warfare, weaponry, and the casualty. Vol 5. Conventional warfare: ballistic, blast, and burn injuries. Office of the Surgeon General, Department of the Army, Washington, DC, pp 53–82 Bellamy RF, Zajtchuk R (1991) Assessing the effectiveness of conventional weapons. Textbook of military medicine. Part I. Warfare, weaponry, and the casualty. Vol 5. Conventional warfare: ballistic, blast, and burn injuries. Office of the Surgeon General, Department of the Army, Washington, DC, pp 53–82
23.
go back to reference Beebe GW, DeBakey ME (1952) Death from wounding. Battle casualties. Charles C Thomas, Springfield, pp 74–147 Beebe GW, DeBakey ME (1952) Death from wounding. Battle casualties. Charles C Thomas, Springfield, pp 74–147
24.
go back to reference Reister FA (1973) Battle casualties and medical statistics. U.S. Army experience in the Korean war. The Surgeon General, Department of the Army, Washington, DC Reister FA (1973) Battle casualties and medical statistics. U.S. Army experience in the Korean war. The Surgeon General, Department of the Army, Washington, DC
26.
go back to reference Mader TH, Carroll RD, Slade CS et al (2006) Ocular war injuries of the Iraqi insurgency, January–September 2004. Ophthalmology 113:97–104PubMedCrossRef Mader TH, Carroll RD, Slade CS et al (2006) Ocular war injuries of the Iraqi insurgency, January–September 2004. Ophthalmology 113:97–104PubMedCrossRef
27.
go back to reference Eastridge BJ, Mabry RL, Seguin P et al (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma 73:S431–S437CrossRef Eastridge BJ, Mabry RL, Seguin P et al (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma 73:S431–S437CrossRef
28.
go back to reference Clarke JE, Davis PR (2012) Medical evacuation and triage of combat casualties in Helmand Province, Afghanistan: October 2010–April 2011. Mil Med 177:1261–1266PubMedCrossRef Clarke JE, Davis PR (2012) Medical evacuation and triage of combat casualties in Helmand Province, Afghanistan: October 2010–April 2011. Mil Med 177:1261–1266PubMedCrossRef
29.
go back to reference Butler F (2003) Tactical combat casualty care: combining good medicine with good tactics. J Trauma 54:S2–S3PubMedCrossRef Butler F (2003) Tactical combat casualty care: combining good medicine with good tactics. J Trauma 54:S2–S3PubMedCrossRef
31.
go back to reference Waes OJF, Van Riet PA, Van Lieshout EMM et al (2012) Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center. Eur J Trauma Emerg Surg 38:543–551PubMedCrossRefPubMedCentral Waes OJF, Van Riet PA, Van Lieshout EMM et al (2012) Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center. Eur J Trauma Emerg Surg 38:543–551PubMedCrossRefPubMedCentral
33.
go back to reference Hoencamp R, Tan ECTH, Idenburg FJ et al (2014) Challenges in training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg. doi:10.1007/s00068-014-0401-z Hoencamp R, Tan ECTH, Idenburg FJ et al (2014) Challenges in training of military surgeons: experiences from Dutch combat operations in southern Afghanistan. Eur J Trauma Emerg Surg. doi:10.​1007/​s00068-014-0401-z
Metadata
Title
Impact of Explosive Devices in Modern Armed Conflicts: In-Depth Analysis of Dutch Battle Casualties in Southern Afghanistan
Authors
Rigo Hoencamp
Eelco P. Huizinga
Thijs T. C. F. van Dongen
Floris J. Idenburg
Arul Ramasamy
Luke P. H. Leenen
Jaap F. Hamming
Publication date
01-10-2014
Publisher
Springer US
Published in
World Journal of Surgery / Issue 10/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2645-5

Other articles of this Issue 10/2014

World Journal of Surgery 10/2014 Go to the issue