US Rangers in Somalia: An Analysis of Combat Casualties on an Urban Battlefield

## Robert L. Mabry, MD, John B. Holcomb, MD, Andrew M. Baker, MD, Clifford C. Cloonan, MD, John M. Uhorchak, MD, Denver E. Perkins, MD, Anthony J. Canfield, MD, and John H. Hagmann, MD

The Journal of TRAUMA Injury, Infection, and Critical Care, 2000, Volume 49(3)

#### Description with Key Points:

This study was undertaken to determine the differences in injury patterns between soldiers equipped with modern body armor in an urban environment compared with the soldiers of the Vietnam War. From July1998 to March 1999, data were collected for a retrospective analysis on all combat casualties sustained by United States military forces in Mogadishu,Somalia, on October 3 and 4, 1993. This was the largest and most recent urban battle involving United States ground forces since the Vietnam War.

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There were 125 combat casualties. Casualty distribution was similar to that of Vietnam; 11% died on the battlefield, 3% died after reaching a medical facility, 47% were evacuated, and 39% returned to duty. No missiles penetrated the solid armor plate protecting the combatants? anterior chests and upper abdomens. Most fatal penetrating injuries were caused by missiles entering through areas not protected by body armor, such as the face, neck, pelvis, and groin. Three patients with penetrating abdominal wounds died from exsanguination, and two of these three died after damage-control procedures.

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At the time of this study, United States Army doctrine on prehospital care did not include antibiotic administration by medics in the field. Information on field use of antibiotics in this battle is only anecdotal, but it seems that very few of the casualties received antibiotics before reaching a casualty collection point or hospital. Early administration of antibiotics to combat casualties is recommended in many studies. The NATO Emergency War Surgery Handbook suggests that parenteral antibiotics be given as early as possible to all patients with penetrating abdominal injuries, open comminuted fractures, and extensive soft-tissue extremity wounds. Because evacuation to definitive surgical care is likely to be delayed more than 6 hours in future urban conflicts, antibiotic therapy should be initiated by medics in the field, preferably within the first hour of injury.

US Army Rangers in Somalia: An Analysis of Combat Casualties on an Urban Battlefield
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# Take Home Message:

The incidence of fatal head wounds in Somalia was similar to that in Vietnam in spite of modern Kevlar helmets.
Body armor reduced the number of fatal penetrating chest injuries.
Penetrating wounds to the unprotected face, groin, and pelvis caused significant mortality.
Mogadishu 1993, Casualties: 58, Wound Infections: 16, Infection rate: 28%, Time from wounding to Level II care ? 15 hrs.
Antibiotics must be given early to prevent wound infections.
Wound infections can kill the casualty or delay recovery.