UK specialist cardiothoracic management of thoracic injuries in military casualties sustained in the wars in Iraq and Afghanistan

Abstract

Morbidity and mortality associated with significant thoracic injury is low at UK R4. Follow-up is required to assess long-term outcomes. Specialist cardiothoracic support and intervention was required in the management of complex thoracic trauma. Early specialist support at R4 may improve morbidity and outcomes associated with life-threatening thoracic injury.

Chinese expert consensus on echelons treatment of thoracic injury in modern warfare

“…This was mainly due to the widespread use of protective equipment, improvement of first aid in the battlefield, rapid evacuation, which allows more soldiers with severe thoracic injuries to be evacuated to treatment facilities than in previous wars, and an improved registration system for wounded soldiers. All these improvements led to more soldiers with severe thoracic injuries being included in the statistics than those for previous wars, which led to the “unexpected” increase in the mortality of wounded soldiers with wartime thoracic injury in OEF/OIF [ 3 – 6 ]. Moreover, unlike previous wars such as the Vietnam War, blast injuries surpassed gunshot injuries in OEF/OIF and became a major cause of thoracic injury.…”

“…It is a major cause of injury and death in warfare and accounts for approximately 1–3% of all preventable wartime casualties [ 1 – 7 ]. In the United States (US)-led Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), the epidemiological features and treatment needs for wartime thoracic injury were different than those in previous wars [ 3 – 6 ]. Currently, there are no uniform guidelines for the treatment of wartime thoracic injuries in the modern battlefield of the Chinese People’s Liberation Army (PLA).…”

Microbiology and risk factors associated with war-related wound infections in the Middle East

“…Primary wound closure after debridement creates tension at the wound edges, which consequently compromises blood supply, increases the risk of infection and wound dehiscence [58]. Early drainage of haemothoraces, avoidance of thoracotomy as primary treatment, and the separate treatment of abdominal and thoracic injuries have also contributed to lower infection rates in patients with chest injuries [43, 73]. In countries such as Syria, where bacterial resistance is likely as a result of wide over-the-counter use of antibiotics [26, 74], hospitals in bordering countries receiving casualties are taking extra measures to ensure appropriate infection control practices including routine microbiological screening on admission, the use of a specific trauma room for immediate resuscitation, and the introduction of isolation bays on the wards [24].…”