Injuries from roadside improvised explosive devices.
BACKGROUND
After the invasion of Iraq in April 2003, coalition forces have remained in the country in a bid to maintain stability and support the local security forces. The improvised explosive device (IED) has been widely used by the insurgents and is the leading cause of death and injury among Coalition troops in the region.


METHODS
From January 2006, data were prospectively collected on 100 consecutive casualties who were either injured or killed in hostile action. Mechanism of injury, new Injury Severity Score (NISS), The International Classification of Disease-9th edition diagnosis, anatomic pattern of wounding, and operative management were recorded in a trauma registry. The weapon incident reports were analyzed to ascertain the type of IED employed.


RESULTS
Of the 100 casualties injured in hostile action, 53 casualties were injured by IEDs in 23 incidents (mean 2.3 casualties per incident). Twenty-one of 23 (91.3%) of the IEDs employed were explosive formed projectile (EFP) type. Twelve casualties (22.6%) were either killed or died of wounds. Median NISS score of survivors was 3 (range, 1-50). All fatalities sustained unsurvivable injuries with a NISS score of 75. Primary blast injuries were seen in only 2 (3.8%) and thermal injuries in 8 casualties (15.1%). Twenty (48.7%) of survivors underwent surgery by British surgeons in the field hospital. At 18 months follow, all but one of the United Kingdom Service personnel had returned to military employment.


CONCLUSIONS
The injury profile seen with EFP-IEDs does not follow the traditional pattern of injuries seen with conventional high explosives. Primary blast injuries were uncommon despite all casualties being in close proximity to the explosion. When the EFP-IED is detonated, the EFP produced results in catastrophic injuries to casualties caught in its path, but causes relatively minor injuries to personnel sited adjacent to its trajectory. Improvements in vehicle protection may prevent the EFP from entering the passenger compartments and thereby reduce fatalities.
Academic Department of Military Surgery and Trauma, ICT Centre, Birmingham, United Kingdom. arul49@doctors.org.uk
Arul
A
Ramasamy
Stuart E
SE
Harrisson
Jon C
JC
Clasper
Michael P M
MP
Stewart
D000328:Adult; D001753:Blast Injuries / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002423:Cause of Death; D053834:Explosive Agents / Q000009:adverse effects; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D038801:International Classification of Diseases; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D016019:Survival Analysis; D006113:United Kingdom; D014857:Warfare; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery
D053834:Explosive Agents