Invasion vs insurgency: US Navy/Marine Corps forward surgical care during Operation Iraqi Freedom.
OBJECTIVE
The transition from maneuver warfare to insurgency warfare has changed the mechanism and severity of combat wounds treated by US Marine Corps forward surgical units in Iraq.


METHODS
Case series comparison.


METHODS
Forward Resuscitative Surgical System units in Iraq.


METHODS
Three hundred thirty-eight casualties treated during the invasion of Iraq in 2003 (Operation Iraqi Freedom I [OIF I]) and 895 casualties treated between March 2004 and February 2005 (OIF II).


METHODS
Definitive and damage control procedures for acute combat casualties.


METHODS
Mechanism of injury, procedures performed, time to presentation, and killed in action (KIA) and died of wounds (DOW) rates.


RESULTS
More major injuries occurred per patient (2.4 vs 1.6) during OIF II. There were more casualties with fragment wounds (61% vs 48%; P = .03) and a trend toward fewer gunshot wounds (33% vs 43%; P = .15) during OIF II. More damage control laparotomies (P = .04) and more soft tissue debridements (P < .001) were performed during OIF II. The median time to presentation for critically injured US casualties during OIF I and OIF II were 30 and 59 minutes, respectively. The KIA rate increased from 13.5% to 20.2% and the DOW rate increased from 0.88% to 5.5% for US personnel in the First Marine Expeditionary Force area of responsibility.


CONCLUSIONS
The transition from maneuver to insurgency warfare has changed the type and severity of casualties treated by US Marine Corps forward surgical units in Iraq. Improvised explosive devices, severity and number of injuries per casualty, longer transport times, and higher KIA and DOW rates represent major differences between periods. Further data collection is necessary to determine the association between transport times and mortality rates.
Department of Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, M61, Cleveland, OH 44195, USA. brethas@ccf.org
Stacy A
SA
Brethauer
Alex
A
Chao
Lowell W
LW
Chambers
Donald J
DJ
Green
Carlos
C
Brown
Peter
P
Rhee
Harold R
HR
Bohman
D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000379:methods*; D008889:Military Personnel / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D015996:Survival Rate / Q000639:trends; D014187:Transportation of Patients / Q000458:organization & administration*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery*