We have heard reports about this phenomenon for months — from Health Day – Marine forward surgical units see patients with more injuries, and more fragment wounds during insurgency, than during the original invasion of Iraq:
Stacy A. Brethauer, M.D., of the Cleveland Clinic in Ohio, and colleagues compared factors related to 338 casualties treated during the invasion of Iraq in 2003, also known as Operation Iraqi Freedom (OIF), and 895 casualties treated between March 2004 and February 2005.
The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by the U.S. Marine Corps Forward Resuscitative Surgery System units in Iraq have treated have evolved since the invasion of Iraq due to factors including improvised explosive devices and longer transport times, according to research published in the June issue of the Archives of Surgery.
More major injuries occurred per patient (2.4 versus 1.6) between March 2004 and February 2005. There were more casualties with fragment wounds (61% versus 48%; P = .03) and a trend toward fewer gunshot wounds (33% versus 43%; P = .15) between March 2004 and February 2005.
More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during this same period. The median time to presentation for critically injured US casualties during OIF and in the later group were 30 and 59 minutes, respectively. The killed in action rate increased from 13.5% to 20.2% and the died of wounds rate increased from 0.88% to 5.5% for US personnel in the First Marine Expeditionary Force area of responsibility.
The transition from maneuver to insurgency warfare has changed the type and severity of casualties treated by US Marine Corps forward surgical units in Iraq. Improvised explosive devices, severity and number of injuries per casualty, longer transport times, and higher death rates represent major differences between periods. Further data collection is necessary to determine the association between transport times and mortality rates.
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