A Profile of Combat Injury

## Howard R. Champion, FRCS(Edin), FACS, Ronald F. Bellamy, MD, FACS, COL, US Army, Ret., Colonel P. Roberts, MBE, QHS, MS, FRCS, L/RAMC, and Ari Leppaniemi, MD, PhD

The Journal of TRAUMA, Injury, Infection, and Critical Care

J Trauma. 2003;54:S13?S19.

#### Description with Key Points:

Traumatic combat injuries differ from those encountered in the civilian setting in terms of epidemiology, mechanism of wounding, pathophysiologic trajectory after injury, and outcome. Except for a few notable exceptions, data sources for combat injuries have historically been inadequate. Although the pathophysiologic process of dying is the same (i.e., dominated by exsanguination and central nervous system injury) in both the civilian and military arenas, combat trauma has unique considerations with regard to acute resuscitation, including (1) the high energy and high lethality of wounding agents; (2) multiple causes of wounding; (3) preponderance of penetrating injury; (4) persistence of threat in tactical settings; (5) austere, resource-constrained environment; and (5) delayed access to definitive care. Recognition of these differences can help bring focus to resuscitation research for combat settings and can serve to foster greater civilian-military collaboration in both basic and transitional research.

Key Chart:
A Profile of Combat Injury
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## Take Home Message:

The Wound Data Munitions Effectiveness Team (WDMET) database suggests that exsanguination from extremity wounds accounts for more than half of the potentially preventable deaths in combat, thus the continued emphasis on hemostasis as the primary maneuver in combat casualty care and the research emphasis on agents that might provide a means of decreasing inaccessible or uncontrollable hemorrhage. Other potentially preventable deaths include simple airway obstruction and other sources of hemorrhage that are surgically remediable if such care can be provided in a timely fashion.
We can use this data to help us understand what types of injuries are seen in combat and which may or may not be survivable.
The causes of death for Soldiers who died in Vietnam demonstrates that a significant number of deaths occur from problems addressed by TCCC, including exsanguination from extremity wounds, airway obstruction, and tension pneumothorax.