Invasion vs insurgency: US Navy/Marine corps forward surgical care during operation iraqi freedom

Stacy A. Brethauer, Alex Chao, Lowell W. Chambers, Donald J. Green, Carlos Brown, Peter Rhee, Harold R. Bohman

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Hypothesis: The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by US Marine Corps forward surgical units in Iraq. Design: Case series comparison. Setting: Forward Resuscitative Surgical System units in Iraq. Patients: Three hundred thirty-eight casualties treated during the invasion of Iraq in 2003 (Operation Iraqi Freedom I [OIF I]) and 895 casualties treated between March 2004 and February 2005 (OIF II). Interventions: Definitive and damage control procedures for acute combat casualties. Main Outcome Measures: Mechanism of injury, procedures performed, time to presentation, and killed in action (KIA) and died of wounds (DOW) rates. Results: More major injuries occurred per patient (2.4 vs 1.6) during OIF II. There were more casualties with fragment wounds (61% vs 48%; P = .03) and a trend toward fewer gunshot wounds (33% vs 43%; P = .15) during OIF II. More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during OIF II. The median time to presentation for critically injured US casualties during OIF I and OIF II were 30 and 59 minutes, respectively. The KIA rate increased from 13.5% to 20.2% and the DOW rate increased from 0.88% to 5.5% for US personnel in the First Marine Expeditionary Force area of responsibility. Conclusions: 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 KIA and DOW rates represent major differences between periods. Further data collection is necessary to determine the association between transport times and mortality rates.

Original languageEnglish (US)
Pages (from-to)564-569
Number of pages6
JournalArchives of Surgery
Volume143
Issue number6
DOIs
StatePublished - Jun 2008

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2003-2011 Iraq War
Military Personnel
Iraq
Wounds and Injuries
Gunshot Wounds
Debridement

ASJC Scopus subject areas

  • Surgery

Cite this

Brethauer, S. A., Chao, A., Chambers, L. W., Green, D. J., Brown, C., Rhee, P., & Bohman, H. R. (2008). Invasion vs insurgency: US Navy/Marine corps forward surgical care during operation iraqi freedom. Archives of Surgery, 143(6), 564-569. https://doi.org/10.1001/archsurg.143.6.564

Invasion vs insurgency : US Navy/Marine corps forward surgical care during operation iraqi freedom. / Brethauer, Stacy A.; Chao, Alex; Chambers, Lowell W.; Green, Donald J.; Brown, Carlos; Rhee, Peter; Bohman, Harold R.

In: Archives of Surgery, Vol. 143, No. 6, 06.2008, p. 564-569.

Research output: Contribution to journalArticle

Brethauer, SA, Chao, A, Chambers, LW, Green, DJ, Brown, C, Rhee, P & Bohman, HR 2008, 'Invasion vs insurgency: US Navy/Marine corps forward surgical care during operation iraqi freedom', Archives of Surgery, vol. 143, no. 6, pp. 564-569. https://doi.org/10.1001/archsurg.143.6.564
Brethauer, Stacy A. ; Chao, Alex ; Chambers, Lowell W. ; Green, Donald J. ; Brown, Carlos ; Rhee, Peter ; Bohman, Harold R. / Invasion vs insurgency : US Navy/Marine corps forward surgical care during operation iraqi freedom. In: Archives of Surgery. 2008 ; Vol. 143, No. 6. pp. 564-569.
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abstract = "Hypothesis: The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by US Marine Corps forward surgical units in Iraq. Design: Case series comparison. Setting: Forward Resuscitative Surgical System units in Iraq. Patients: Three hundred thirty-eight casualties treated during the invasion of Iraq in 2003 (Operation Iraqi Freedom I [OIF I]) and 895 casualties treated between March 2004 and February 2005 (OIF II). Interventions: Definitive and damage control procedures for acute combat casualties. Main Outcome Measures: Mechanism of injury, procedures performed, time to presentation, and killed in action (KIA) and died of wounds (DOW) rates. Results: More major injuries occurred per patient (2.4 vs 1.6) during OIF II. There were more casualties with fragment wounds (61{\%} vs 48{\%}; P = .03) and a trend toward fewer gunshot wounds (33{\%} vs 43{\%}; P = .15) during OIF II. More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during OIF II. The median time to presentation for critically injured US casualties during OIF I and OIF II were 30 and 59 minutes, respectively. The KIA rate increased from 13.5{\%} to 20.2{\%} and the DOW rate increased from 0.88{\%} to 5.5{\%} for US personnel in the First Marine Expeditionary Force area of responsibility. Conclusions: 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 KIA and DOW 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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AB - Hypothesis: The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by US Marine Corps forward surgical units in Iraq. Design: Case series comparison. Setting: Forward Resuscitative Surgical System units in Iraq. Patients: Three hundred thirty-eight casualties treated during the invasion of Iraq in 2003 (Operation Iraqi Freedom I [OIF I]) and 895 casualties treated between March 2004 and February 2005 (OIF II). Interventions: Definitive and damage control procedures for acute combat casualties. Main Outcome Measures: Mechanism of injury, procedures performed, time to presentation, and killed in action (KIA) and died of wounds (DOW) rates. Results: More major injuries occurred per patient (2.4 vs 1.6) during OIF II. There were more casualties with fragment wounds (61% vs 48%; P = .03) and a trend toward fewer gunshot wounds (33% vs 43%; P = .15) during OIF II. More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during OIF II. The median time to presentation for critically injured US casualties during OIF I and OIF II were 30 and 59 minutes, respectively. The KIA rate increased from 13.5% to 20.2% and the DOW rate increased from 0.88% to 5.5% for US personnel in the First Marine Expeditionary Force area of responsibility. Conclusions: 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 KIA and DOW 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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