Abstract
Recent advances in combat casualty care have enabled survival following battlefield injuries that would have been lethal in past conflicts. While some injuries remain beyond our current capability to treat, they have the potential to be future ‘unexpected’ survivors. The greatest threat to deployed coalition troops currently and for the foreseeable future is the improvised explosive device (IED) Therefore, the aim of this study was to conduct an analysis of causes of death and injury patterns in recent explosive blast fatalities in order to focus research and mitigation strategies, to further improve survival rates.
Since November 2007, UK Armed Forces personnel killed whilst deployed on combat operations undergo both a post mortem computed tomography (PMCT) scan and an autopsy. With the permission of the coroners, we analysed casualties with PMCTs between November 2007 and July 2010. Injury data were analysed by a pathology-forensic radiology-orthopaedic multidisciplinary team. Cause of death was attributed to the injuries with the highest AIS scores contributing to the NISS score. Injuries with an AIS < 4 were excluded. During the study period 227 PMCT scans were performed; 211 were suitable for inclusion, containing 145 fatalities due to explosive blast from IEDs. These formed the study group. 24 cases had such severe injuries (disruptions) that further study was inappropriate. Of the remaining 121, 79 were dismounted, and 42 were mounted (in vehicles).
Leading causes of death were head CNS injury (47.6%), followed by intra-cavity haemorrhage (21.7%) in the mounted group, and extremity haemorrhage (42.6%), junctional haemorrhage (22.2%) and head CNS injury (18.7%) in the dismounted group.
The severity of head trauma in both mounted and dismounted IED fatalites would indicate that prevention and mitigation of these injuries is likely to be the most effective strategy to decrease their resultant mortality. Two thirds of dismounted fatalities have haemorrhage implicated as a cause of death that may have been amenable to prehospital treatment strategies. One fifth of mounted fatalites have haemorrhagic trauma which currently could only be addressed surgically. Maintaining the drive to improve all haemostatic techniques for combat casualties from point of wounding to definitive surgical proximal control alongside development and application of novel haemostatics could yield a significant survival benefit.
