Background
Common use of body armor (BA) and kevlar helmets by soldiers has lead to a change in war penetrating injuries.
Methods
From 2002 to 2005, the anaesthesiologist and surgical staff of the Military Hospital Laveran, Marseille, France, participated in the combat support hospital for an international task force during peacekeeping operations in Kosovo, Afghanistan and Ivory Coast. Prospective data were collected on all combat casualties affecting wounded soldiers equipped with BA.
Results
One hundred and sixteen wounded soldier cases wearing BA were included. The incidence of bullet wounds was 2%, of shell/rockets was 47%, of fragments of grenade was 16%, of mines was 6% and of bombing explosions was 29%. Injuries topographically affected the head, groin and neck (23%), thorax (10%), abdomen (3%) and extremities (96%).
Twelve percent died on the battlefield. Eighty-two percent of wounded soldiers reached the medical facility before 25 ± 15 min and were evacuated with a medical team to the combat support hospital in 127 ± 65 min between attack and admission; vital emergencies accounted for 17%, including 83% of hemorrhagic shock, 28% of respiratory distress and 11% of coma. After surgical care, the wounded soldiers had strategic medical evacuation to a military hospital in France in 37 ± 15 hours.
Discussion
In the urban battlefield since Sarajevo (1992–1996) and Mogadishu (1993), bullet wounds of soldiers equipped with BA were higher (60%) than in our study (2%), whereas fragment injuries were fewer (30% vs 98%) [1,2]. Without BA, injuries affected the head and face (11%), chest (19.5%), abdomen (25.8%) and limbs (68.9%). In our study, penetrating injuries affected essentially the limbs (100%) and head (23%), but the thorax (10%) and abdomen (3%) were protected. The incidence of fatal wounds was similar in spite of modern BA (11–12%) but vital emergencies decreased in our study (17%) compared with injuries in the urban battlefield (44%). In the battlefield, delayed evacuations were typical because of unsafe air space, but wounded soldiers could receive fast medical facility and evacuation to intensive care and surgical support.
Conclusion
Modern BA has reduced the number of fatal penetrating chest and abdominal injuries, and vital emergencies have decreased, but not the death rate, despite the efficiency of the combat medical support chain, because of specific employing of weapons (lethal injuries due to sniping, in the urban battlefield, aerial attacks, mine or bombing explosions).