title: Penetrating missile injuries during asymmetric warfare in the 2003 Gulf conflict.
abstract: BACKGROUND
  War wounds produce a significant burden on medical facilities in wartime. Workload from the recent conflict was documented in order to guide future medical needs.
  
  
  METHODS
  All data on war injuries were collected prospectively. This information was supplemented with a review of all patients admitted during the study period.
  
  
  RESULTS
  During the first 2 weeks of the conflict, the sole British field hospital in the region received 482 casualties. One hundred and four were battle injuries of which nine were burns. Seventy-nine casualties had their initial surgery performed by British military surgeons and form the study group. Twenty-nine casualties (37 per cent) sustained gunshot wounds, 49 (62 per cent) suffered wounds from fragmentation weapons and one casualty detonated an antipersonnel mine. These 79 patients had a total of 123 wounds that were scored prospectively using the Red Cross Wound Classification. Twenty-seven (34 per cent) of the wounded were non-combatants; eight of these were children. Four patients (5 per cent) died.
  
  
  CONCLUSIONS
  War is changing; modern conflicts appear likely to be fought in urban or remote environments, producing different wounding patterns and placing non-combatants in the line of fire. Military medical skills training and available resources must reflect these fundamental changes in preparation for future conflicts.
authors.affiliation: Department of Trauma and Orthopaedics, Nuffield Orthopaedic Centre, Headington, Oxford, UK. DEHinsley@aol.com <DEHinsley@aol.com>
authors.forename: D E
authors.initials: DE
authors.lastname: Hinsley
authors.forename: P A E
authors.initials: PA
authors.lastname: Rosell
authors.forename: T K
authors.initials: TK
authors.lastname: Rowlands
authors.forename: J C
authors.initials: JC
authors.lastname: Clasper
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001753:Blast Injuries / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007493:Iraq; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000453:epidemiology; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000453:epidemiology; D014857:Warfare; D014948:Wounds, Gunshot / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000453:epidemiology*