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NousDefionsDoc
04-28-2004, 15:03
Body armor is fast becoming a way of life, both for troops and LEOs. What differences can we expect in likely wounds, wound characteristics, DX/TX, etc. if any?

Roguish Lawyer
04-28-2004, 15:09
Originally posted by NousDefionsDoc
Body armor is fast becoming a way of life, both for troops and LEOs. What differences can we expect in likely wounds, wound characteristics, DX/TX, etc. if any?

How about fewer penetrating gunshot wounds to the chest? :D

The Reaper
04-28-2004, 15:15
Originally posted by NousDefionsDoc
Body armor is fast becoming a way of life, both for troops and LEOs. What differences can we expect in likely wounds, wound characteristics, DX/TX, etc. if any?


Increased head (and eye) injuries and wounds to the extremities.

TR

The Reaper
04-28-2004, 15:16
FYI.

TR

Washington Post
April 27, 2004
Pg. 1

The Lasting Wounds Of War

Roadside Bombs Have Devastated Troops and Doctors Who Treat Them

By Karl Vick, Washington Post Foreign Service

BAGHDAD -- The soldiers were lifted into the helicopters under a moonless sky, their bandaged heads grossly swollen by trauma, their forms silhouetted by the glow from the row of medical monitors laid out across their bodies, from ankle to neck.

An orange screen atop the feet registered blood pressure and heart rate. The blue screen at the knees announced the level of postoperative pressure on the brain. On the stomach, a small gray readout recorded the level of medicine pumping into the body. And the slender plastic box atop the chest signaled that a respirator still breathed for the lungs under it.

At the door to the busiest hospital in Iraq, a wiry doctor bent over the worst-looking case, an Army gunner with coarse stitches holding his scalp together and a bolt protruding from the top of his head. Lt. Col. Jeff Poffenbarger checked a number on the blue screen, announced it dangerously high and quickly pushed a clear liquid through a syringe into the gunner's bloodstream. The number fell like a rock.

"We're just preparing for something a brain-injured person should not do two days out, which is travel to Germany," the neurologist said. He smiled grimly and started toward the UH-60 Black Hawk thwump-thwumping out on the helipad, waiting to spirit out of Iraq one more of the hundreds of Americans wounded here this month.

While attention remains riveted on the rising count of Americans killed in action -- more than 100 so far in April -- doctors at the main combat support hospital in Iraq are reeling from a stream of young soldiers with wounds so devastating that they probably would have been fatal in any previous war.

More and more in Iraq, combat surgeons say, the wounds involve severe damage to the head and eyes -- injuries that leave soldiers brain damaged or blind, or both, and the doctors who see them first struggling against despair.

For months the gravest wounds have been caused by roadside bombs -- improvised explosives that negate the protection of Kevlar helmets by blowing shrapnel and dirt upward into the face. In addition, firefights with guerrillas have surged recently, causing a sharp rise in gunshot wounds to the only vital area not protected by body armor.

The neurosurgeons at the 31st Combat Support Hospital measure the damage in the number of skulls they remove to get to the injured brain inside, a procedure known as a craniotomy. "We've done more in eight weeks than the previous neurosurgery team did in eight months," Poffenbarger said. "So there's been a change in the intensity level of the war."

Numbers tell part of the story. So far in April, more than 900 soldiers and Marines have been wounded in Iraq, more than twice the number wounded in October, the previous high. With the tally still climbing, this month's injuries account for about a quarter of the 3,864 U.S. servicemen and women listed as wounded in action since the March 2003 invasion.

About half the wounded troops have suffered injuries light enough that they were able to return to duty after treatment, according to the Pentagon.

The others arrive on stretchers at the hospitals operated by the 31st CSH. "These injuries," said Lt. Col. Stephen M. Smith, executive officer of the Baghdad facility, "are horrific."

By design, the Baghdad hospital sees the worst. Unlike its sister hospital on a sprawling air base located in Balad, north of the capital, the staff of 300 in Baghdad includes the only ophthalmology and neurology surgical teams in Iraq, so if a victim has damage to the head, the medevac sets out for the facility here, located in the heavily fortified coalition headquarters known as the Green Zone.

Once there, doctors scramble. A patient might remain in the combat hospital for only six hours. The goal is lightning-swift, expert treatment, followed as quickly as possible by transfer to the military hospital in Landstuhl, Germany.

While waiting for what one senior officer wearily calls "the flippin' helicopters," the Baghdad medical staff studies photos of wounds they used to see once or twice in a military campaign but now treat every day. And they struggle with the implications of a system that can move a wounded soldier from a booby-trapped roadside to an operating room in less than an hour.

"We're saving more people than should be saved, probably," Lt. Col. Robert Carroll said. "We're saving severely injured people. Legs. Eyes. Part of the brain."

Carroll, an eye surgeon from Waynesville, Mo., sat at his desk during a rare slow night last Wednesday and called up a digital photo on his laptop computer. The image was of a brain opened for surgery earlier that day, the skull neatly lifted away, most of the organ healthy and pink. But a thumb-sized section behind the ear was gray.

"See all that dark stuff? That's dead brain," he said. "That ain't gonna regenerate. And that's not uncommon. That's really not uncommon. We do craniotomies on average, lately, of one a day."

"We can save you," the surgeon said. "You might not be what you were."

Accurate statistics are not yet available on recovery from this new round of battlefield brain injuries, an obstacle that frustrates combat surgeons. But judging by medical literature and surgeons' experience with their own patients, "three or four months from now 50 to 60 percent will be functional and doing things," said Maj. Richard Gullick.

"Functional," he said, means "up and around, but with pretty significant disabilities," including paralysis.

The remaining 40 percent to 50 percent of patients include those whom the surgeons send to Europe, and on to the United States, with no prospect of regaining consciousness. The practice, subject to review after gathering feedback from families, assumes that loved ones will find value in holding the soldier's hand before confronting the decision to remove life support.

"I'm actually glad I'm here and not at home, tending to all the social issues with all these broken soldiers," Carroll said.

But the toll on the combat medical staff is itself acute, and unrelenting.

In a comprehensive Army survey of troop morale across Iraq, taken in September, the unit with the lowest spirits was the one that ran the combat hospitals until the 31st arrived in late January. The three months since then have been substantially more intense.

"We've all reached our saturation for drama trauma," said Maj. Greg Kidwell, head nurse in the emergency room.

On April 4, the hospital received 36 wounded in four hours. A U.S. patrol in Baghdad's Sadr City slum was ambushed at dusk, and the battle for the Shiite Muslim neighborhood lasted most of the night. The event qualified as a "mass casualty," defined as more casualties than can be accommodated by the 10 trauma beds in the emergency room.

"I'd never really seen a 'mass cal' before April 4," said Lt. Col. John Xenos, an orthopedic surgeon from Fairfax. "And it just kept coming and coming. I think that week we had three or four mass cals."

The ambush heralded a wave of attacks by a Shiite militia across southern Iraq. The next morning, another front erupted when Marines cordoned off Fallujah, a restive, largely Sunni city west of Baghdad. The engagements there led to record casualties.

"Intellectually, you tell yourself you're prepared," said Gullick, from San Antonio. "You do the reading. You study the slides. But being here . . . ." His voice trailed off.

"It's just the sheer volume."

In part, the surge in casualties reflects more frequent firefights after a year in which roadside bombings made up the bulk of attacks on U.S. forces. At the same time, insurgents began planting improvised explosive devices (IEDs) in what one officer called "ridiculous numbers."

The improvised bombs are extraordinarily destructive. Typically fashioned from artillery shells, they may be packed with such debris as broken glass, nails, sometimes even gravel. They're detonated by remote control as a Humvee or truck passes by, and they explode upward.

To protect against the blasts, the U.S. military has wrapped many of its vehicles in armor. When Xenos, the orthopedist, treats limbs shredded by an IED blast, it is usually "an elbow stuck out of a window, or an arm."

Troops wear armor as well, providing protection that Gullick called "orders of magnitude from what we've had before. But it just shifts the injury pattern from a lot of abdominal injuries to extremity and head and face wounds."

The Army gunner whom Poffenbarger was preparing for the flight to Germany had his skull pierced by four 155mm shells, rigged to detonate one after another in what soldiers call a "daisy chain." The shrapnel took a fortunate route through his brain, however, and "when all is said and done, he should be independent. . . . He'll have speech, cognition, vision."

On a nearby stretcher, Staff Sgt. Rene Fernandez struggled to see from eyes bruised nearly shut.

"We were clearing the area and an IED went off," he said, describing an incident outside the western city of Ramadi where his unit was patrolling on foot.

The Houston native counted himself lucky, escaping with a concussion and the temporary damage to his open, friendly face. Waiting for his own hop to the hospital plane headed north, he said what most soldiers tell surgeons: What he most wanted was to return to his unit.

Roguish Lawyer
04-28-2004, 15:17
Originally posted by The Reaper
Increased head (and eye) injuries and wounds to the extremities.

TR

From deflections off the armor? Or are these injuries that would have occurred anyway but are still happening due to limitations on the armor's coverage?

Roguish Lawyer
04-28-2004, 15:20
Interesting article, TR. I guess it suggests that there is an "increase" in injuries in that, without the body armor, you'd have a KIA instead of a wounded soldier needing treatment.

Surgicalcric
04-28-2004, 15:27
I think more soldiers will be treated for blast, small arms injuries that would have been casualty producing in years past.

More amputations and burns for sure.

The Reaper
04-28-2004, 15:27
Exactly.

More KIAs, or more surgeons doing "Chest Cutting".

Also the bad guys have changed techniques, tactics and procedures to create casualties despite the armor.

We will not be discussing those here.

TR

Roycroft201
04-28-2004, 16:28
Question after reading the article TR posted re: battlefield brain injuries.

Article stated 50-60% will become 'functional'.

40-50% will not regain conciousness and are stabilized so families back home can have closure before the person expires.

So my question is, there must be a 'gray area' that some patients fall into for the neurosurgeons regarding how far the surgeon will go in trying to repair a brain injury. Do soldiers carry something akin to a "DNR" order, for lack of a better term ( on dog tags perhaps ?) regarding how far they want the medical personnel to go ?

The weight carried on the shoulders by the medical professionals in the field has to be excruciating at times.

Roycroft201

NousDefionsDoc
04-28-2004, 16:32
roycroft,
Do a search, we've discussed DNRs on here already.

Roycroft201
04-28-2004, 18:09
Done. Thanks, NDD. That's what I get for not hanging out in the medical forums all the time. It must be something subliminal about your avatar:D

RC201

DoctorDoom
04-28-2004, 23:02
x

The Reaper
04-29-2004, 06:41
Originally posted by DoctorDoom
Sir,

Do you mean increased percentage of these wounds as center-mass wounds drop due to armor, or increased total number as more enemies aim for the unarmored parts?

The former.

The percentages increase as the number of thoracic wounds decrease.

TR

DoctorDoom
04-29-2004, 07:20
x

NousDefionsDoc
04-29-2004, 13:51
Originally posted by The Reaper
The former.

The percentages increase as the number of thoracic wounds decrease.

TR

Agreed. What I don't have are armor hits that didn't cause a "wound". The Colombian contractor that was KIAd (a friend) was, from what I was told, shot in the head while sitting in a vehicle. Now that may have been because that was the visible target or because they thought he was wearing armor (I don't know if he was or not).

I am making a semi-educated guess here, but I would imagine armor is causing overall survivability to go up, with a corresponding increase in extremity wounds, amputations, etc. This is not a bad thing. You can live a long and productive life without a leg, people do it everyday.

The other thing that is impacting I think are the tactics. Roadside IEDs causing different injuries, in some cases, than one might normally think of on a battlefield. But this is not new. Ambushes in Vietnam, I read somwhere that most casualties in WWII were caused by artillery fire (I don't know if that's right), etc.

I'm not sure the hadjis are "aiming" for extremities due to body armor, from what I have been told, most of them are not competent enough to do that and as Reaper said, not for discussion on an open board.

What interests me, as a medic is:
1. Armor is here to stay
2. What does armor change in regards to the most likely wounds given a particular tactic
3. How will the armor change wound characteristics
4. What special considerations will TX a PT with armor imply

For example, despite the movies, a round to the armor over the heart can cause significant blunt trauma, tamponade, etc. I know of one case where an SF soldier was hit in the chest with a pistol round, was fine, and crashed later. He survived, but it was not looking good for a while. That implies to me that despite appearances, they may not really be fine afterall. I'd hate to have a teammate survive a GSW only to go south on me later.

We may have a completely unstudied trauma as well. High speed MVA accidents where all victims are wearing armor. We have studies out the ying yang of MVAs, but with armor? What will having your vehicle flip over while wearing IBA change in regard to wounds, if anything? What about helo crashes? Can we expect more seatbelt-type injuries to the abdomen/lower back where the armor breaks on the body?

Anybody care to hazard a guess as to why so many FXd spines are around L5 on HALO jumps? I have my own theory (based on first hand knowledge).

These are the kinds of thoughts I am hoping to provoke.

Just thinking out loud.

NousDefionsDoc
04-29-2004, 13:52
Doc T says she has some recent cases of GSWs with armor she will post when she has a chance.

Surgicalcric
04-29-2004, 14:07
Good questions NDD on the possible effects and resultant injuries from wearing IBA. Let me think about that and I will respond on them in a bit.

I do however have a case of III-A armor (Point Blank) saving a paramedic's life here in Greenville, not once but twice. First incident (2) .357's to the chest/abd, the second (3) .38's in the back. Both resulted in Fx ribs. He is still at it and is an asshole most of the time.

I dont get on the Bus without it. Thank God.

Another paramedic was shot in the mouth by a pateint and when questioned about why he aimed for the face she told investigators it was because she had read in the newspaper that many paramedics now wear armor. The medic is still alive, but was medically retired.

Roguish Lawyer
04-29-2004, 14:09
Fx = broken? fractured?

Anyone willing to do a little SOAP glossary for interested lurkers?

NousDefionsDoc
04-29-2004, 14:16
Don't get me wrong, I'm in favor of armor as long as it meets the threat and is worn properly.

RL - roger FX is fracture. Sorry about that. Just ask if you need clarification.

Surgicalcric
04-29-2004, 14:22
Originally posted by NousDefionsDoc
Don't get me wrong, I'm in favor of armor as long as it meets the threat and is worn properly.

Did not take it otherwise before NDD. Just thought I would throw those out there.

As for meeting the threat: it would appear from the incident a few weeks ago in San Fransisco patrol officers may need to add ceramic plates to their armor to meet that threat.


EMS here now issues III-A vests in exterior carriers too all employees. It is not now, but it will soon be a mandatory uniform item for wear. I said years ago I would find a new job when I had to start wearing IBA, but I am still here and wearing it. Damn I am stubborn.

Surgicalcric
04-29-2004, 14:31
Originally posted by NousDefionsDoc
Anybody care to hazard a guess as to why so many FXd spines are around L5 on HALO jumps? I have my own theory (based on first hand knowledge).

Ass landing?

Solid
04-29-2004, 15:07
Acronym Finder (http://www.acronymfinder.com) is a good place to look for the meaning of Fx, Tx, Dx, Rx etc. It takes a little bit of deducing because many of these acronyms are polysemic, but is a huge help and lets the medics talk unimpeded.

Sorry for intruding,

Solid

Jack Moroney (RIP)
04-29-2004, 15:39
I can remember when we first started using body armor that other problems arose that presented a whole new set of operational parameters. Damn things don't do much for floatation so operations in and around water becomes a new challenge. You are really going to have to watch the weak swimmers. Also there are restrictions as to what areas you can move in and out of so in some CQB situations where the size of the entrance way is limited consequently folks tend to want to remove plates or risk getting hung up in places providing more exposure over time until they can work their way through the openings. Heat injuries will probably increase. I have also seen false senses of bravado by folks that feel that they have extra protection so that they are less concerned about using available cover and concealment. Sort of reminds me of the cambodes who thought as long as they had a number one Budda hanging around their neck or clenched in their teeth that they were bullet proof. I have also seen one individual do stupid things that he would not have otherwise done in weapons handling because he felt folks were protected by their body armor. The result was a GSW to the back where there was no plate. So from my non-medic standpoint I think while you might not be seeing as many chest injuries you are going to be dealing with wounds that might not have killled folks outright before but they will be bleeding out from wounds that would not have been previously the primary cause of death . Then there will always be joe tent peg, you know him he is the same guy that would have pulled his filters out of his gas mask because it was easier to breath. He will be removing chest plates and stowing them in his ruck and his leaders will be thinking that because he is wearing armor that what they are asking him to do is an acceptable risk because he is "protected". Folks will be checking for wounds other than those to the armored areas when he goes down and might miss the real problem.

Jack Moroney