The severity of combat wounds in Iraq increased significantly when the war shifted from invasion to counter-insurgency. In the June issue of Archives of Surgery, Stacy Brethauer. M.D. reported that in comparison to the invasion phase there has been a 50% increase in the mean number of major injuries per patient and in the percentage of patients dying before a physician could see them. The study compared 338 casualties treated by Marine Corps surgical team in March and April of 2003 with 895 treated from March 2004 to February 2005.The study looked at the causative factors in the increase, namely the increase in injuries from IED's, mortars and rocket propelled grenades as the combat shifted from invasion to guerrilla warfare. During the invasion phase 48% of the casualties had fragmentation wounds rising to 61% in the counter-insurgency phase. The rate of physician treated injuries who later died increased from 0.88% during the invasion to 5.5% during the counter-insurgency.The wounded individuals who arrive at battlefield hospitals are undergoing more procedures. This is attributed to the types of wounds caused by IED's and other explosive weapons. The body armor worn by soldiers and the armor on vehicles is inadequate in light of the explosive forces of IED's and other weapons inherent in this phase of the conflict.The military has addressed the more immediate transport of severely injured soldiers to surgical units in an effort to reduce mortality and provide more rapid response to the devastating injuries.
The Iraq and Afghanistan wars have brought about many advances in trauma medicine which will trickle down into the emergency rooms in our country as trauma surgeons and nurses return. But, the reality of the war is that the type of combat involving our troops is causing more severe and multiple injuries with a much higher death rate. We will see soldiers with very severe disabilities arising from multiple trauma returning home. Brain injury has been called "the signature wound" of the Iraq and Afghanistan War. We can expect that individuals with even more severe brain injuries and multi trauma related disabilities will be requiring rehabilitation and life time support as they leave military hospitals. Are we ready?