Land mine injuries: a study of 708 victims in North Iraq and Cambodia.
OBJECTIVE
The aim of this study was to explore the effect of low-cost prehospital trauma systems on trauma outcome in land mine victims and to study prehospital risk indicators for better triage of land mine injuries.


METHODS
A 5-year prospective study of the effect of in-field advanced life support provided by local paramedics was conducted in mine-infested areas in North Iraq and Cambodia.


RESULTS
After implementation of a rural rescue system, there was a significant reduction in trauma mortality from 26.2% in 1997 to 11.8% in 2001 (95% confidence interval for difference, 5.1%-23.6%). The mortality rate was significantly higher in fragmentation mine victims, 25.2%, as compared with blast mine victims, 5.7% (95% confidence interval for difference, 14.4%-24.6%). The severity of associated fragment injuries in patients with traumatic amputations is a solid risk predictor (area under the curve in receiver operating characteristics plots > 0.9).


CONCLUSIONS
Low-cost prehospital trauma systems improve trauma outcome in land mine victims where prehospital transit times are high. The fragment wounds represent the main challenge for trauma care providers.
Husum
Hans
H
Tromsoe Mine Victim Resource Center, P.O. Box 80, N-9038, University Hospital of Northern Norway. tmc@unn.no
Gilbert
Mads
M
Wisborg
Torben
T
Van Heng
Yang
Y
Murad
Mudhafar
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001753:Blast Injuries / Q000145:classification / Q000453:epidemiology* / Q000601:surgery; D002160:Cambodia / Q000453:epidemiology; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D007493:Iraq / Q000453:epidemiology; D008297:Male; D018570:Risk Assessment; D015996:Survival Rate; D014218:Triage / Q000706:statistics & numerical data