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Kriegschirurgische Verletzungsmuster

UPDATE 2007

Patterns of injury in a combat environment

2007 update

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Zusammenfassung

Problemstellung

Epidemiologische Analysen von Verletzungsmustern und -mechanismen sind von Interesse, um fachliche Anforderungen an den vor Ort agierenden Chirurgen und Weiterbildungskonzepte abzuleiten. Es soll daher erarbeitet werden, welche operativ tätigen Fachgebiete und besondere Fachkompetenzen bei einem Einsatz in einem Krisengebiet wesentlich sind.

Methodik

Mittels Medline- (1949–2007) und Google-Recherche wurde eine Datenanalyse der Todesursachen im Afghanistan- und Irakeinsatz durchgeführt.

Ergebnisse

Als Verletzungsursache sind von Bedeutung Granaten mit hochenergetischer Splitterwirkung, Gewehrschussverletzungen, Flugunfälle und terroristische Angriffe. Durch Feindeinwirkung („hostile related“) wurden 55% und „nonhostile related“ 45% der Soldaten getötet. Als Todesursachen werden für „Killed-in-action-Soldaten“ in erster Linie Thorax-, Abdomen- (40%) und Schädel-Hirn-Verletzungen (35%) genannt. Im Irakkrieg beträgt die „case fatality rate“ annähernd die Hälfte des Vietnamkrieges. Im Gegensatz dazu zeigt sich eine Verdoppelung der Amputationsrate. Ca. 8–15% der tödlich endenden Verletzungen erscheinen vermeidbar.

Schlussfolgerungen

Der Militärchirurg muss lebensrettende Notfallmaßnahmen im Bereich der Thorax-, Viszeral- und Gefäßchirurgie beherrschen sowie praktische Fähigkeiten im Bereich der Neuro- und Mund-Kiefer-Gesichts-Chirurgie besitzen. Entscheidend sind zudem ausreichende MedEVAC-Kapazitäten. Zu fordern ist eine einheitliche Registrierung aller Verletzungen in Anlehnung an das DGU-Traumaregister.

Abstract

Background

Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas.

Methods

MEDLINE (1949–2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed.

Results

The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8–15% of the deaths appeared to be preventable.

Conclusions

Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.

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Abbreviations

AKUF:

Arbeitsgemeinschaft Kriegsursachenforschung

CFR:

Case fatality rate = Anteil aller Getöteten an allen Getöteten und Verwundeten

DOW:

Died of wounds = Anteil aller Getöteten nach Erreichen der ersten ärztlichen Versorgung an allen Verwundeten abzüglich der Verwundeten, die innerhalb von 72 h wieder ihren Dienst aufnehmen konnten (! der Nenner von DOW und KIA ist nicht identisch, daher kann keine Summe gebildet werden)

ICRC:

International Committee of the Red Cross

IED:

Improvised explosive device

KIA:

Killed in action = Anteil aller Getöteten bis zum Erreichen der ersten ärztlichen Versorgung an allen Getöteten und Verwundeten abzüglich der Verwundeten, die innerhalb von 72 h wieder ihren Dienst aufnehmen konnten

MSF:

Médecins Sans Frontières

RTD:

Returned to duty = Verwundete, die innerhalb von 72 h wieder ihren Dienst aufnehmen können

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Authors and Affiliations

  1. Chirurgische Klinik , Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland

    C. Willy, R. Steinmann & M. Engelhardt

  2. Institut für Pathologie, Universität von Würzburg, Würzburg, Deutschland

    H.-U. Voelker

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  1. C. Willy
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  2. H.-U. Voelker
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  3. R. Steinmann
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  4. M. Engelhardt
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Correspondence to C. Willy.

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Willy, C., Voelker, HU., Steinmann, R. et al. Kriegschirurgische Verletzungsmuster. Chirurg 79, 66–76 (2008). https://doi.org/10.1007/s00104-007-1403-8

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