Identifying future ‘unexpected’ survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices

Abstract

ObjectivesTo identify potentially fatal injury patterns in explosive blast fatalities in order to focus research and mitigation strategies, to further improve survival rates from blast trauma.DesignRetrospective cohort study.ParticipantsUK military personnel killed by improvised explosive device (IED) blasts in Afghanistan, November 2007–August 2010.SettingUK military deployment, through NATO, in support of the International Security Assistance Force (ISAF) mission in Afghanistan.Data sourcesUK military postmortem CT records, UK Joint Theatre Trauma Registry and associated incident data.Main outcome measuresPotentially fatal injuries attributable to IEDs.ResultsWe identified 121 cases, 42 mounted (in-vehicle) and 79 dismounted (on foot), at a point of wounding. There were 354 potentially fatal injuries in total. Leading causes of death were traumatic brain injury (50%, 62/124 fatal injuries), followed by intracavity haemorrhage (20.2%, 25/124) in the mounted group, and extremity haemorrhage (42.6%, 98/230 fatal injuries), junctional haemorrhage (22.2%, 51/230 fatal injuries) and traumatic brain injury (18.7%, 43/230 fatal injuries) in the dismounted group.ConclusionsHead trauma severity in both mounted and dismounted IED fatalities indicated prevention and mitigation as the most effective strategies to decrease resultant mortality. Two-thirds of dismounted fatalities had haemorrhage implicated as a cause of death that may have been anatomically amenable to prehospital intervention. One-fifth of the mounted fatalities had haemorrhagic trauma which currently could only be addressed surgically. Maintaining the drive to improve all haemostatic techniques for blast casualties, from point of wounding to definitive surgical proximal vascular control, alongside the development and application of novel haemostatic interventions could yield a significant survival benefit. Prospective studies in this field are indicated.

The Mortality Peer Review Panel: a report on the deaths on operations of UK Service personnel 2002–2013

“…The results of this paper point to the overwhelming severity and nature of military trauma described in other studies14 15 especially given the proportion of injuries caused by improvised explosive devices. Data from the Vietnam War and previous modern conflicts showed a preponderance of single life-threatening injuries 16.…”

Environment at the time of injury determines injury patterns in pelvic blast

“…Blast effects to buildings and people can be affected by characteristics of the explosive, surrounding infrastructure and the area in which it detonates 4. Military personnel have been shown to sustain different injury patterns if wounded on foot, and wounded in vehicle 5. Within vehicles, the majority of fatalities can be attributed to head injury,6 and to a slightly lesser extent, torso trauma 7.…”

“…This comprised traumatic lower limb amputation, and often more proximal pelvic and perineal injury,12 in which fatality was high 13. Although previous studies on military cohorts have linked the environment to particular wounding patterns in calcaneal fractures14 and the spine,5 no studies exist on pelvic trauma and the influence of the surroundings on its pattern. A strong investment in applied personnel protective equipment during the recent conflicts anecdotally reduced fatalities; however, casualties still died from this complicated wounding pattern 15.…”

Ethics surrounding the medical evacuation of catastrophically injured individuals from an operational theatre of war

“…In the last five years, 246 soldiers suffered traumatic, often multiple limb amputations, with associated severe abdominal, pelvic or genitourinary injuries. Traumatic injuries were usually a result of improvised explosive devices, the most prevalent cause of fatal battlefield injury in Afghanistan 5 6…”