Impact of combat conditions on casualties and surgical care

BACKGROUND: Modern armed conflicts evolve rapidly, resulting in changes in combat scenarios, tactical settings, and military medicine. This, in turn, influences the prevalence of combat-related surgical injuries, with a significant effect on the scope and type of surgical care provided during the early stages of casualty evacuation. The medical evacuation support system established at the beginning of the military operation is currently facing new challenges. These include providing medical care throughout a lengthy prehospital phase as well as the need for specialty care and military medical examination for the increasing number of light casualties in the active army.

AIM: This work aimed to assess the prevalence of combat-related surgical injuries as well as the type and scope of surgical care in various combat scenarios of a modern regional conflict.

METHODS: Data on casualties that required surgical treatment were pooled and analyzed for several forward medical facilities of individual medical battalions, including those of reinforced combat teams, during a modern armed conflict.

RESULTS: Modern warfare is evolving rapidly, as evidenced by the fact that three-fourths of patients admitted to tertiary care were injured as a result of unmanned aerial vehicle attacks. Changes in combat conditions have significantly altered the prevalence of combat-related surgical injuries and the type of surgical care provided. The longer time to casualty evacuation for specialty surgical care is the most significant change influencing the current medical evacuation support system. Other changes, including the decreased proportion of severe and extremely severe wounds (by 15.4%), the increased proportion of minor wounds (by 49.9%), the decreased incidence of penetrating wounds (by 45.2%), and the increased incidence of isolated wounds (by 53.2%), facilitate secondary and tertiary casualty evacuation.

CONCLUSION: The changes discussed above are primarily associated with a longer time to casualty evacuation for specialty surgical care. These changes signify a new, significant challenge for tactical medicine during a lengthy prehospital phase. Specialized military hospitals for light casualties deployed in a combat area and its immediate vicinity have reduced the need for casualty evacuation to rear military medical facilities.