title: Surgical response to multiple casualty incidents following single explosive events.
abstract: BACKGROUND
  Modern publications on response to single explosive events are from non-US hospitals, predate current resuscitation guidelines and lack detail on surgical and intensive care unit (ICU) requirements. The objective of this study is to provide a contemporary account of surge response to multiple casualty incidences following explosive events managed at a US trauma hospital in Iraq.
  
  
  METHODS
  Observational study and retrospective chart review of 72-hour transfusion, operating room, and ICU resource utilization from 3 multiple casualty incidences managed at the US Air Force Theater Hospital, Balad AB, Iraq between February and April 2008.
  
  
  RESULTS
  Fifty patients were treated with a mean injury severity score of 19. Forty-eight percent (n = 24) of casualties required blood transfusion with 4 patients receiving 43% (N = 74 units) of the packed red blood cells (pRBC). An average of 3.5 and 3.8 units of pRBC and plasma, respectively, was transfused per casualty (pRBC:plasma ratio of 1:1.1). Seventy-six percent (n = 38) of patients required immediate operation upon initial presentation. A total of 191 procedures were performed in parallel during 75 operations (3.8 procedures per casualty). Fifty percent (n = 25) of patients required ICU admission with nearly the same number (n = 24) requiring mechanical ventilator support beyond that required for operation. All cause, in-hospital mortality was 8% (n = 4).
  
  
  CONCLUSIONS
  Results from this study provide a contemporary assessment of transfusion, surgical, and intensive care resource requirements after a single explosive event. Data from this experience may translate into useful guidelines for emergency planners worldwide.
authors.affiliation: The 332nd Expeditionary Medical Group/Air Force Theater Hospital Balad Air Base, Iraq.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Propper
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.forename: Scott B
authors.initials: SB
authors.lastname: Davidson
authors.forename: Sheri L
authors.initials: SL
authors.lastname: Vandenberg
authors.forename: W Darrin
authors.initials: WD
authors.lastname: Clouse
authors.forename: Gabe E
authors.initials: GE
authors.lastname: Burkhardt
authors.forename: Shaun M
authors.initials: SM
authors.lastname: Gifford
authors.forename: Jay A
authors.initials: JA
authors.lastname: Johannigman
mesh_terms: D001753:Blast Injuries / Q000453:epidemiology / Q000628:therapy*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data; D005107:Explosions; D006760:Hospitalization / Q000706:statistics & numerical data; D006772:Hospitals, Military; D006801:Humans; D054542:Iraq War, 2003-2011; D054527:Mass Casualty Incidents; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data