Spectrum of Care Provided at an Echelon II Medical Unit during Operation Iraqi Freedom

Abstract

We describe the types of medical problems encountered at a U.S. Army echelon II medical facility during Operation Iraqi Freedom in the period after completion of major ground combat operations, a time of nation restructuring and intermittent, intense, armed conflict. A total of 4,831 patients were assessed between October 1, 2003 and June 30, 2004, 74% with disease and nonbattle injury presentations, 19% with dental complaints, and 7% wounded in action (WIA). Disease and nonbattle injury evaluations were predominantly musculoskeletal. Improvised explosive devices or mortars caused 78% of the WIA casualties. The most frequent dental evaluations were for restorations (47%). Thirty-eight individuals were admitted to holding beds, most commonly to receive intravenous antibiotic treatment for cellulitis (29%). Three hundred forty-one individuals were evacuated, including 150 WIA. Determining the types of casualties seen at forward echelons of medical care during different phases of conflict can aid medical planning and help predict the type of medical resources required.

Pathology of blast-related brain injury

“…Injuries caused by IEDs result from blast wave-induced changes in atmospheric pressure (primary blast injury), from objects projected from the blasts into people (secondary blast injury), and from people being propelled from the blast (tertiary blast injury) [1][2]. A recent study found that 47 percent of blast-related injuries in Iraq involved the head [3]. Early literature describes a condition in which soldiers coming in contact with powerful explosions were rendered unconscious or dazed when no external injury was noted.…”

Neuropsychological Outcomes of U.S. Veterans with Report of Remote Blast-Related Concussion and Current Psychopathology

“…Explosive blast represents a common injury mechanism (Murray et al, 2005;Nelson et al, in press;Owens et al, 2008;Sayer et al, 2008;Wilk et al, 2010), and it appears that combat-related concussion, blast-related concussion (BRC) in particular, may be unprecedented in the current conflicts (Owens et al, 2008;Warden, 2006). Many returning OEF/OIF personnel with concussion histories report cognitive limitations for months or even years post-injury.…”

Análisis del agente lesivo en la baja de combate: Experiencia de la Sanidad Militar española desplegada en Herat (Afganistán)

“…A pesar Tabla 5. Distribución por autores del mecanismo lesivo empleado [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . de ser conflictos diferentes, presentan gran similitud desde un punto de vista logístico-operativo y asistencial.…”

“…Este dato es semejante al obtenido en prácticamente la totalidad de estudios anglosajones que analizan las bajas atendidas en los conflictos más recientes 36-38, 40-42,45-50 . Este hecho también es característico del enfrentamiento entre tropas profesionales e insurgentes, ocurrido en ambiente urbano, desértico o montañoso y en la denominada «guerra asimétrica» [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] . Entre otros factores, se puede destacar que las medidas de protección pasiva (blindaje de vehículos, casco y chaleco antifragmentos) y la rápida evacuación hasta una instalación médica, reducen la morbimortalidad en los heridos que han sufrido lesiones por arma de fuego y por explosivos (en inglés Improvised Explosive Device, IED).…”