Comparison Between Patients Treated at a Combat Support Hospital in Iraq and a Level I Trauma Center in the United States.

摘要

The delivery of medicine during war time presents numerous complex challenges that differ significantly from civilian practice. Medical care in the Global War on Terrorism is delivered 12,000 miles from home. Conditions are austere and resources are limited forcing caregivers to draw on all of their medical expertise. The safety of personnel cannot be guaranteed as American hospitals represent strategic targets for terrorists. Care is delivered both to American soldiers, coalition forces, and noncoalition forces spanning incredibly diverse cultural populations. Both routine and unusual medical problems must be treated as well as combat casualties. The operational tempo is intense as mass casualty incidents are common and US patients are transported from the Mideast to Germany and then to the United States frequently in less than 4 days, receiving operations at each destination. Modern combat wounding patterns differ dramatically from those seen in civilian practice. High powered explosives like improvised explosive devices, rocket propelled grenades, and rockets or mortars have been reported to produce 55% of the casualties seen. High powered automatic rifles are typically used as opposed to handguns in civilian casualties. Despite these facts, overall mortality has been shown to be comparable between a Forward Resuscitative Surgical System functioning in Iraq and a major urban Level I trauma center in the United States. The overall case fatality rate in Iraq is 9.1% which is the lowest in recorded war time history and roughly half of that recorded in World War II and Vietnam. The potentially preventable death rate has been reported to be 15% and the majority of these deaths are from hemorrhage. Better training could play a significant role in improving this statistic.