Even more critical medicine: a retrospective analysis of casualties admitted to the intensive care unit in the Spanish Military Hospital in Herat (Afghanistan)

Navarro Suay, R.; Bartolomé Cela, E.; Jara Zozaya, I.; Hernández Abadía de Barbará, A.; Gutiérrez Ortega, C.; García Labajo, J.D.; Planas Roca, A.; Gilsanz Rodríguez, F.

doi:10.1016/S2173-5727(11)70020-0

Article information

Abstract

Objective

To analyze casualties from firearm and explosives injuries who were admitted to the Intensive Care Unit in the Spanish ROLE-2E from December 2005 to December 2008 and to evaluate which damaging agent had produced the highest morbidity-mortality in our series using score indices with anatomical base (ISS and NISS).

Design

Observational and retrospective study performed between 2005 and 2008.

Setting

Polyvalent Intensive Care Unit in the Spanish Military Hospital of those deployed in Afghanistan.

Patients or participants

The inclusion criteria were all patients who had been wounded by firearm or by explosive devices and who had been admitted in ICU in Spanish Military Hospital in Herat (Afghanistan).

Intervention

The anatomic scores Injury Severity Score and the New Injury Severity Score (NISS) were applied to all the selected patients to estimate the grade of severity of their injuries.

Variables of interest

Independent: damaging agent, injured anatomical area, protection measures and dependent: mortality, surgical procedure applied, score severity and sociodemographics and control variables.

Results

Eighty-six casualties, 30 by firearm and 56 by explosive devices. Applying the NISS, 38% of the casualties had suffered severe injuries. Mean stay in the ICU was 2.8 days and mortality was 10%. Significant differences in admission to the ICU for the damaging agent were not observed (P = .142).

Conclusions

No significant differences were observed in the need for admission and stay in the ICU according to the damaging agent. The importance of the strategy, care and logistics of the intensive care military physician in Intensive Medicine in the Operating Room in Afghanistan is stressed.

Keywords:

Casualty

Firearm

IED

ISS

NISS

Afghanistan

ROLE

Resumen

Objetivo

Analizar las bajas por arma de fuego o por explosivo que ingresaron en la UCI del ROLE-2E español entre diciembre de 2005 y diciembre de 2008 y valorar mediante puntuaciones anatómicas de gravedad (ISS y NISS) cuál es el agente lesional que ha producido mayor morbimortalidad en nuestra serie.

Diseño

Estudio observacional retrospectivo efectuado entre los años 2005 y 2008.

Ámbito

Unidad de Cuidados Intensivos polivalente del Hospital Militar español desplegado en Afganistán.

Pacientes o participantes

El criterio de inclusión fue el de todos los pacientes que sufrieron heridas por arma de fuego o lesiones por artefacto explosivo y que fueron ingresados en la UCI del Hospital Militar español de Herat (Afganistán).

Intervenciones

A los pacientes seleccionados se les aplicó las puntuaciones anatómicas Injury Severity Score (ISS) y New Injury Severity Score (NISS) para estimar el grado de gravedad de sus lesiones.

Variables de interés

Independientes: agente lesional, área anatómica afectada, empleo de medios de protección, y dependientes: mortalidad, necesidad de intervención quirúrgica, gravedad según scores, y sociodemográficas y de control.

Resultados

Ochenta y seis bajas; 30 por arma de fuego y 56 por artefacto explosivo. El 38% estaba valorado como grave por NISS. La estancia media fue de 2,8 días y la mortalidad del 10%. No se observan diferencias significativas de ingresos en UCI según el agente lesional (p = 0,142).

Conclusiones

No se observan diferencias significativas en necesidad de ingreso y de la estancia en UCI según el agente causante de las lesiones. Se destaca la importancia táctica, asistencial y logística del médico militar especialista en medicina intensiva en el teatro de operaciones de Afganistán.

Palabras clave:

Baja

Arma de fuego

IED

ISS

NISS

Afganistán

ROLE

Full text is only aviable in PDF

References

[1.]

P. Armero, F. Carrillo.

Afganistán. En El Ejército del Aire en Operaciones de Paz.

Ministerio de Defensa. June, (2004),

[2.]

Available from: www.mde.es/areasTemáticas/misiones [accessed 2010 Aug 22]

[3.]

Medical Support, Concept., In:, NATO., ISAF., VIII., Medical, Handbook., Kabul: ISAF; 2005. p. 6-15.

[4.]

J.B. Lundy, C.B. Swift, C.C. McFarland, P. Mahoney, R.M. Perkins, J.B. Holcomb.

A descriptive analysis of patients admitted to Intensive Care Unit of the 110th Combat Support Hospital deployed in Ibn Sinba, Baghdad Iraq, from October 19, 2005, to October 19 2006.

J Intensive Care Med, 25 (2010), pp. 156-162

http://dx.doi.org/10.1177/0885066609359588 | Medline

[5.]

K.W. Grathwohl, S.G. Venticinque.

Organizational characteristics of the austere intensive care unit: The evolution of military trauma and critical care medicine;applications for civilian medical care system.

Crit Care Med, 36 (2008), pp. 275-283

[6.]

S. Villanueva Serrano, J.M. Martinez, F. Herrera, A. Hernández-Abadía.

Bajas por munición explosiva Experiencia española en la antigua Yugoslavia.

Med Mil, 53 (1997), pp. 339-343

[7.]

E. Fernández.

La Legión vuelve a Afganistán.

RED, 3 (2010), pp. 14-16

[8.]

R. Navarro, E. Bartolomé, I. Jara, A. Oreja, G. González.

Capacidades y asistencia sanitaria realizada por el ROLE-2 español en la FSB de Herat (Afganistán) desde febrero a julio del 2007.

Sanid Mil, 64 (2008), pp. 98-104

[9.]

Generalidades. In: OR7-603. Orientaciones Sanidad en Operaciones. Granada: Ejército de Tierra español. Mando de Adiestramiento y Doctrina; 2006. p. 1–9.

[10.]

R. Navarro.

Bajas por arma de fuego y explosivos Experiencia del Hospital Militar español desplegado en Heart (Afganistán) 2005–2008 doctoral thesis.

Universidad Autónoma de Madrid, (2009),

[11.]

G. Peoples, T. Gerlinger, R. Craig.

Burlingame. Combat casualties in Afghanistan cared for by a single Foward Surgical Team during the initial phases of Operation Enduring Freedom.

Mil Med, 170 (2005), pp. 462-468

Medline

[12.]

C.J. Fox, D.L. Gillespie, S.D. O’Donnell, T.E. Rasmussen, J.M. Goff, C.A. Johnson, et al.

Contemporary management of wartime vascular trauma.

J Vasc Surg, 41 (2005), pp. 638-644

http://dx.doi.org/10.1016/j.jvs.2005.01.010 | Medline

[13.]

B.D. Owens, J.F. Kragh, J. Macaitis, S.J. Svoboda, J.C. Wenke.

Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom.

J Orthop Trauma, 21 (2007), pp. 254-257

http://dx.doi.org/10.1097/BOT.0b013e31802f78fb | Medline

[14.]

A. Beekley, D.M. Watts.

Combat trauma experience with the United States Army 102nd Foward Surgical Team in Afghanistan.

Am J Surg, 187 (2004), pp. 652-654

http://dx.doi.org/10.1016/j.amjsurg.2004.02.001 | Medline

[15.]

A. Beitler, G.W. Wortmann, L.J. Hofmann, J.M. Goff.

Operation Enduring Freedom: the 48th Combat Support Hospital in Afghanistan.

Mil Med, 171 (2006), pp. 189-193

Medline

[16.]

D.E. Hinsley, P.A. Rosell, T.K. Rowlands, J.C. Clasper.

Penetrating missile injuries during asymmetric warfare in the 2003 Gulf conflict.

Br J Surg, 92 (2005), pp. 637-642

http://dx.doi.org/10.1002/bjs.4911 | Medline

[17.]

S.A. Brethauer, A. Chao, L.W. Chambers, D.J. Green, C. Brown, P. Rhee, et al.

Invasion vs insurgency: US Navy/Marine Corps forward surgical care during Operation Iraqi Freedom.

Arch Surg, 143 (2008), pp. 564-569

http://dx.doi.org/10.1001/archsurg.143.6.564 | Medline

[18.]

J.M. Zouris, A.L. Wade, C.P. Magno.

Injury and illness casualty distributions among US Army and Marine Corps personnel during Operation Iraqi Freedom.

Mil Med, 173 (2008), pp. 247-252

Medline

[19.]

S. Bird, C. Fairweather.

Military fatality rates (by cause) in Afghanistan and Iraq: a measure of hostilities.

Int J Epidemiol. Advance Access published, 142 (2007), pp. 21-31

[20.]

T. Ramalingam.

Extremity injuries remain a high surgical workload in a conflict zone: experiences of a British Field Hospital in Iraq, 2003.

J R Army Med Corp, 150 (2004), pp. 187-190

[21.]

R.J. Place, R.M. Rush, E.D. Arrington.

Forward surgical team (FST) workload in a special operation environment: the 250th FST in Operation ENDURING FREEDOM.

Curr Surg, 60 (2003), pp. 418-422

http://dx.doi.org/10.1016/S0149-7944(02)00718-3 | Medline

[22.]

A.L. Wade, J.L. Dye, C.R. Mohrle, M.R. Galarneau.

Head, face, and neck injuries during Operation Iraqi Freedom II: results from the US Navy-Marine Corps Combat Trauma Registry.

J Trauma, 63 (2007), pp. 836-840

http://dx.doi.org/10.1097/01.ta.0000251453.54663.66 | Medline

[23.]

L.W. Chamber, D.J. Green, B.L. Gillingham, K. Sample, P. Rhee, C. Brown, et al.

The experience of the US Marine Corps’ Surgical Shock Trauma Platoon with 417 operative combat casualties during a 12 month period of operation Iraqi Freedom.

J Trauma, 60 (2006), pp. 1155-1161

http://dx.doi.org/10.1097/01.ta.0000220340.91356.7e | Medline

[24.]

Sheffy, Y. Mintz, A.I. Rivkind, S.C. Aspira.

Terror-related injuries: a comparison of gunshot wound versus secondary-fragments-induced from explosives.

J Am Coll Surg, 203 (2006), pp. 297-303

http://dx.doi.org/10.1016/j.jamcollsurg.2006.05.010 | Medline

[25.]

Available from: www.icosmaps.net [accessed 2009 May 20].

[26.]

D. Jenkins, P. Dougherty.

The effects of bullets.

Ballistic Trauma, 2nd ed., pp. 40-44

[27.]

T. Osler, L. Glance, J.S. Buzas, D. Mukamel, J. Wagner, A. Dick.

A trauma mortality prediction model based on the anatomic injury scale.

Ann Surg, 247 (2008), pp. 1041-1048

http://dx.doi.org/10.1097/SLA.0b013e31816ffb3f | Medline

[28.]

R. Tamburri, A. Fernández.

Logística sanitaria.

1st ed., pp. 425-435

[29.]

T. Hodgetts, S. Davies, M. Midwinter, R. Russell, J. Smith, J. Clasper, et al.

Operational Mortality of UK Service Personnel in Iraq and Afghanistan: A one year analysis 2006-7.

JR Army Med Corps, 153 (2007), pp. 252-254

[30.]

J.F. Kelly, A.E. Ritenour, D.F. McLaughlin, K.A. Bagg, A.N. Apodaca, C.T. Mallak, et al.

Injury Severity and cause of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006.

J Trauma, 64 (2008), pp. 21-26

[31.]

R.T. Gerhardt, R.A. De Lorenzo, J. Oliver, J.B. Holcomb, J.A. Pfaff.

Out-of-Hospital Combat Casualty Care in the Current War in Iraq.

Ann Emerg Med, 53 (2009), pp. 169-174

http://dx.doi.org/10.1016/j.annemergmed.2008.04.013 | Medline

[32.]

Presentación del nuevo modelo de ambulancias RG-31 (NYALA), por la unidad de apoyo logístico, sanitario., Boletín informativo de Sanidad, Militar., 2010; 4:2.

[33.]

C.F. Rodrigo.

Estabilización y transporte en el medio aéreo.

1st ed., pp. 239-254

[34.]

La Dirección de Sanidad hace entrega de un Escáner al Hospital de la Base de Apoyo Avanzado de Herat. Noticias, 2009 [accessed 2010 Aug 22]. Available from: www.ejercitodelaire. mde.es

[35.]

H.B. Alam, D. Burris, J.A. DaCorta, P. Rhee.

Hemorrhage control in the battlefield: Role of new hemostatic agents.

Mil Med, 170 (2005), pp. 63-69

Medline

[36.]

Primer envío de plasma fresco congelado a zona de operaciones. Boletín informativo de Sanidad Militar. 2009; 1:14.

[37.]

Defensa enviará a partir del 8 de julio de 2010 plaquetas congeladas a Afganistán accessed 2010 Aug 22. Available from: www.mde.es/gabinete/notasPrensa.

[38.]

F.K. Butler, J.B. Holcomb, S.D. Giebner, N.E. McSwain, J. Bagian.

Tactical Combat Casualty Care 2007: evolving concepts and battlefield experience.

Mil Med, 172 (2007), pp. 1-19

Medline

[39.]

L.H. Blackbourne.

Combat damage control surgery.

Crit Care Med, 36 (2008), pp. 304-310

[40.]

B.J. Eastridge.

Utilizing a trauma system approach to benchmark and improve combat casualty care.