Willy C, Voelker H-U, Steinmann R, Engelhardt M
Chirurgische Klinik, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
Chirurg. 2008 Jan;79(1):66-76. doi: 10.1007/s00104-007-1403-8.
Epidemiological analysis of injury patterns and mechanisms help in identifying the expertise that military surgeons need in a combat setting and also in adjusting training requirements accordingly. This paper attempts to assess the surgical specialties and skills of particular importance in the management of casualties in crisis areas.
MEDLINE (1949-2007) and Google search were used. Causes of death among casualties in Afghanistan and the Iraq war were analyzed.
The leading causes of injury were explosive devices, gunshot wounds, aircraft crashes, and terrorist attacks. Of the casualties, 55% died in hostile action and 45% in nonhostile incidents. Chest or abdominal injuries (40%) and brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq was approximately half as high as in the Vietnam War. In contrast, the amputation rate was twice as high. Approximately 8-15% of the deaths appeared to be preventable.
Military surgeons must have excellent skills in the fields of thoracic, visceral, and vascular surgery as well as practical skills in neurosurgery and oral and maxillofacial surgery. It also is of vital importance to ensure the availability of sufficient medical evacuation capabilities. Furthermore, there is a need for a standardized registration system for all injuries similar to the German Trauma Registry.
对损伤模式和机制进行流行病学分析，有助于确定军事外科医生在战斗环境中所需的专业技能，并据此调整培训要求。本文旨在评估在危机地区伤员管理中特别重要的外科专业和技能。
使用MEDLINE（1949 - 2007年）和谷歌搜索。分析了阿富汗和伊拉克战争中伤亡人员的死亡原因。
主要致伤原因是爆炸装置、枪伤、飞机坠毁和恐怖袭击。在伤亡人员中，55%死于敌对行动，45%死于非敌对事件。胸部或腹部损伤（40%）和脑损伤（35%）是阵亡士兵的主要死亡原因。伊拉克的病死率约为越南战争时期的一半。相比之下，截肢率是两倍。约8 - 15%的死亡似乎是可以预防的。
军事外科医生必须在胸外科、内脏外科和血管外科领域具备出色技能，以及神经外科和口腔颌面外科的实践技能。确保有足够的医疗后送能力也至关重要。此外, 需要一个类似于德国创伤登记处的针对所有损伤的标准化登记系统。
