Profiles in Combat Casualties - PowerPoint PPT Presentation

About This Presentation
Title:

Profiles in Combat Casualties

Description:

Profiles in Combat Casualties COL CLIFFORD C. CLOONAN, MD, FACEP Interim Chair Dept. of Military and Emergency Medicine USUHS WAR WOUNDS History, Wound Description ... – PowerPoint PPT presentation

Number of Views:179
Avg rating:3.0/5.0
Slides: 70
Provided by: operationa7
Category:

less

Transcript and Presenter's Notes

Title: Profiles in Combat Casualties


1
Profiles in Combat Casualties
  • COL CLIFFORD C. CLOONAN, MD, FACEP
  • Interim Chair Dept. of Military and
  • Emergency Medicine
  • USUHS

2
WAR WOUNDSHistory, Wound Description, Mechanisms
and Wounding Agents, Distribution of
Wounds/Wounding By Anatomical Location and by
Demography,
  • Following this lecture the participant will be
    able to
  • Discuss why military medical personnel should
    know something about weapons and the effects they
    produce
  • State which wounds are most commonly associated
    with death.

3
WAR WOUNDS
  • Following this lecture the participant will be
    able to (cont.)
  • State the frequency with which the various type
    of combat wounds occur and the impact that type
    of combat, geography, and weapons available have
    on the relative percentages of each type.
  • List the various wounding patterns associated
    with different types of weapons and different
    types of combat
  • State who primarily gets wounded/killed in combat
  • State where in the echeloned combat health care
    system the deaths occur

4
Dulce bellum inexpertis(War is delightful to
those who have no experience of it)Erasmus
5
The Evolution of Weapons of War
6
Wounds of War Historical Background
7
The Invention of Gunpowder
8
Encoded formula for gunpowder and a depiction of
its use
9
HISTORY OF WAR WOUNDS
  • CHANGING PATTERNS OF WOUNDING THROUGHOUT HISTORY
  • EFFECTS OF EVOLVING WEAPONS SYSTEMS
  • EFFECTS OF EVOLVING TACTICS

10
The Modern BattlefieldMore Dangerous and
Violent Than Ever
  • Smart Weapons, Improved conventional munitions
  • Increased probability of multiple hits
  • Automatic Weapons - Multiple hits
  • Decreased proportion of surviving wounded
  • Fragments will cause 80-90 of living wounded
  • More extremity wounds - effects of protective
    equipment

11
Combat Wounds Are Unique
  • High percentage of penetrating wounds
  • Multi-System injury
  • Multi-Etiologic
  • High degree of wound contamination
  • Old (delayed initial care)

12
Highly Contaminated Old Wounds
13
Mechanisms of Combat Injury
14
(No Transcript)
15
Causes of Combat Wounds
(WWI, WWII, Korea, Vietnam, Middle East)
16
Mogadishu Somalia Oct 3 1993
17
Shell Fragment Wound
18
Fragments from exploding anti-tank weapon
19
Landmine Injury
20
(No Transcript)
21
M-16 assault rifle 5.56mm GSW (exit)
22
Trans-Abdominal High Velocity GSW (fatal)
23
Facial Burns Kosovo
24
Napalm Burns Vietnam
25
Burns - The Israeli Experience
  • Six Day War 1967 - 4.6 Burn Injuries
  • October War 1973 - 8.1 Burn Injuries
  • Lebanon War 1982 - 7.6 Burn Injuries

26
Primary Blast Injury
USS Cole Terrorist Bombing
27
Primary Blast Injury
  • Primary Blast Injury is uncommon in most combat
    casualties but
  • In an armored vehicle that has been penetrated by
    a large warhead,1-20 of the survivors will have
    some degree of 1o blast injury in addition to
    other wounds.
  • Primary blast injury is considerably more common
    in casualties due to naval combat

28
War Wound Distribution
Upper Extremities
Lower Extremities
Abdomen
Head Neck
Chest
Other
29
(No Transcript)
30
Mogadishu Raid Casualties Anatomic Wound
Distribution
31
Time to death after initial wounding
32
(No Transcript)
33
(No Transcript)
34
Mechanisms of Injury and Distribution of
Injuries byGeographic Environment and Type of
Combat
35
North Africa
  • Agent Percent
  • Shell fragments...................................
    . 75
  • Bullets...........................................
    ........... 20
  • Mines.............................................
    ........... 2
  • Bombs.............................................
    .......... 1
  • Other.............................................
    ............ 2
  • _____
  • Total............100

36
SOUTH PACIFIC
  • AGENT PERCENT
  • Shell Fragments 50
  • Bullets
  • Rifle 25
  • Machine gun 8
  • Grenade 12
  • Mines 2
  • Other 3 ______
  • Total 100

37
Vietnam
  • Agent Percent
  • Shell Fragments 38.9
  • (Artillery, mortar, rocket)
  • Bullets (rifle and pistol) 23.8
  • Booby traps, mines, grenades 27.7

38
Wounding Agents in the Falklands
  • Gunshot Wounds - 38
  • Fragment- Caused Wounds - 40
  • Burns - 18

39
Sites of Wounding - Falklands
  • Head and Neck - 30/133 (23)
  • Upper Limb - 42/133 (31)
  • Lower Limb - 88/133 (68)
  • Intra-thoracic - 11/133 (8)
  • Intra-peritoneal - 12/133 (8)
  • Multiple Wounding Sites - 59/133 (41)

40
Falklands British Killed Wounded
  • WIA - 783 (75)
  • KIA - 255 (24.5)
  • DOW - 3 (0.3)
  • High percentage of KIAs is probably related to
    high of GSWs and prolonged evacuation times
    (this also probably contributed to a low DOW rate

41
Vietnam - Morbidity Mortality
  • KIA - 11
  • WIA - 87.5 (45.5 CRO)
  • DOW - 1.5

42
Distribution of Wounds By Anatomic Group - Viet
Nam
  • Head and Neck - 16.5
  • Thorax - 7.3
  • Abdomen - 8.0
  • Upper Extremities - 27.7
  • Lower Extremities - 40.5

43
War Wounds
  • Who is wounded / killed in war?

44
Vietnam - Marine Corps Wounded
  • Mean Age - 20.7 years old
  • Distribution by Pay Grade
  • E1 - E3 - 71.2 of those wounded
  • E4 - E6 - 25.6 of those wounded
  • Officers - 2.7 of those wounded

45
Distribution of Wounding in Vietnam by Occupation
  • Infantry - 71.8 of those wounded
  • Artillery - 2.2 of those wounded
  • Direct Correlation between a Lack of Combat
    Experience and Increased Wounding

46
Desert Storm - Cause of Death
47
(No Transcript)
48
(No Transcript)
49
(No Transcript)
50
(No Transcript)
51
  • When only ground troops are studied, the ratio of
    WIA/KIA, which was 4.2/1 in WW II, has remained
    essentially unchanged for the past 200 years.

52
SITE OF EXSANGUINATION IN 98 VIET NAM COMBAT
DEATHS
  • 16 - Heart/Ascending Aorta
  • 13 - Lung/Pulmonary Artery
  • 10 - Liver
  • 10 - Multiple Abdominal Sites
  • 9 - Great Vessels of the Thorax (Principally the
    Aorta)
  • 9 - Arteries in the Lower Extremity
  • 8 - Great Vessels of the Abdomen (especially the
    Aorta/Vena Cava

53
SITE OF EXSANGUINATION IN 98 DEATHS (CONT)
  • 6 Amputations of the lower extremity
  • 3 Carotid Artery
  • 2 Upper Extremity Amputations
  • 2 Arteries of the Upper Extremity (Esp.
    Axillary/Brachial)
  • 10 Mult. Sites in the Chest, Abdomen, and
    Extremities
  • Possibility For Temporary Control of Bleeding
    with First Aid

54
Mortality Rate of Extremity Wounds ()
  • World War II Korea Vietnam
  • Upper 0.1 0.2 0.15
  • Lower 3.0 0.7 0.5

55
  • "BATTLE CASUALTIES, INCIDENCE, MORTALITY, AND
    LOGISTIC CONSIDERATIONS"
  • By
  • Gilbert W. Beebe, Ph.D..
  • Michael E. De Bakey, MD

56
UNDERSTANDING WAR, HISTORY AND THEORY OF COMBAT
  • BY
  • T.N. Dupuy, 1987
  • Paragon House Publishers, N.Y.

57
FACTORS WHICH INFLUENCE WOUNDING RATES ON THE
BATTLEFIELD
  • Ratio of enemy to U.S. strength.
  • Type of weapons employed and ratio of enemy to
    U.S. firepower
  • The experience and training of the troops
  • Terrain
  • Tactical advantage and the excellence of the
    plan.

58
FACTORS WHICH INFLUENCE WOUNDING RATES ON THE
BATTLEFIELD (cont)
  • Availability of prepared positions (enemy vs.
    U.S.)
  • Possession of key terrain (enemy vs. U.S.)
  • Quality of available intelligence
  • Tactical and strategic support
  • Logistic support

59
The site of death for 90 of fatally wounded
combat casualties is the battlefield.
60
Casualty Rates
  • AVERAGE WORLD WAR II DIVISION ENGAGEMENT
  • Casualty rates were 1-3 per day

61
Attrition Rates
  • Attrition Rates in the 1973 Arab-Israeli October
    War Were Comparable to World War II

62
  • It is vital that the medical officer "...be in a
    position to check the tactical situation
    estimates with other staff officers so that his
    plans may be more securely grounded".

63
Quotes
  • VICTORY IS THE
  • BEST MEDICINE

64
Quotes
  • ...Medicine has...an indirect influence on
    war which is not negligible. there seems little
    doubt that some of the reckless courage
    of...American troops...is stimulated by the
    knowledge that in front of them is only
    the...enemy, but behind them...are the
    assembled surgeons of America, with sleeves
    rolled up.
  • Hans Zinsser, Rats, Lice and History

65
Summary
  • Following this lecture the participant will be
    able to
  • Military medical personnel should know something
    about weapons and the effects they produce
    because such knowledge is useful
  • for medical planning purposes
  • to aid in developing or improving wounding
    prevention methods
  • in helping to estimate the number and types of
    casualties that might be generated
  • To improve communication with the line

66
Summary
  • The most common combat wounding mechanisms are
  • Fragments
  • Fragments
  • Fragments
  • Fragments
  • Bullets
  • Bullets
  • Blast and burns and all other (unless you are in
    the navy AND you are assigned to a ship in which
    case blast and burn make up a larger percent)

67
Summary
  • The frequency with which the various type of
    combat wounds occur (see above) all of these
    depend upon type of combat (geography, weapons
    available, type of combat etc.)
  • Fragments (all types) 50 90
  • Bullets lt10 - 50
  • Primary Blast generally lt5
  • Burn (all types) generally lt5

68
Summary
  • Wounding patterns associated with different types
    of weapons
  • For most weapons wounding location is random and
    thus primarily based upon body surface area
    therefore -
  • Extremities which make up roughly 55 of BSA
    account from roughly 55 of sites of wounding
  • Landmines clearly primarily affect the lower
    extremities
  • Some bullets are aimed so there is a slightly
    higher percent of wounds in torso and head
  • Head and neck are injured somewhat
    disproportionate to their BSA because these body
    parts are more commonly exposed (have to be able
    to see to shoot!) -roughly 17 instead of 10

69
Summary
  • Who primarily gets wounded/killed in combat
  • Young men ages 18 24
  • Predominantly infantrymen
  • Almost entirely enlisted men with 2nd Lieutenants
    being at highest risk of death among officers
  • Which wounds most commonly cause death?
  • Head and Chest Wounds
  • Where do most deaths occur?
  • On the battlefield (mostly at the point of
    wounding and within lt5 minutes of wounding)
  • Relatively few die once reaching a hospital
Write a Comment
User Comments (0)
About PowerShow.com