Pilgrim Charles H C, Brennan Leonard
General and Trauma Surgeon, The Alfred Hospital, Melbourne, Australia.
Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
ANZ J Surg. 2023 Apr;93(4):821-828. doi: 10.1111/ans.18141. Epub 2022 Nov 12.
A comprehensive review of the surgical management of injuries sustained by deployed members of the Australian Defence Force (ADF) during Operation SLIPPER and HIGHROAD in Afghanistan has not previously been undertaken. Understanding the mechanism of injury, injury types sustained and surgical intervention undertaken should provide valuable information for future health planning and surgical capability determination.
Retrospective chart review of scanned medical records of injured personnel identified through casualty register examination was undertaken.
There were 259 ADF personnel injured in Afghanistan between January 2002 and December 2021, of which 53 were seriously (SI), or very seriously injured (VSI). Case notes for 90 of 101 casualties including those sustaining VSI, SI and those classified as being in satisfactory condition, but likely requiring surgery and/or returned to Australia following trauma, were available for review. Most patients with VSI/SI required surgery (93%) and most were returned to Australia following injury (91%). Almost two-thirds (64.4%) of initial surgery was undertaken at a Role 2 E medical treatment facility (MTF). Gun-shot wound (GSW) was the commonest injuring mechanism (47%) followed by blast injury (39.6%). Orthopaedic (32.2%) and soft tissue initial wound surgery (47.1%) were the commonest surgical procedures.
Surgical management of military trauma was undertaken at multiple sites by multiple surgical teams from different nationalities delivering exceptional results and conforming to modern principles of damage control surgery. The military trauma system is distinctly different from its civilian counterpart with dispersion of assets requiring multiple episodes of casualty movement between echelons of care rather than centralization at level 1 trauma centres. Despite this, excellent results are achievable. Strengthening lines of communication and documentation would reinforce the ability of the military trauma system to continue to provide such results, and regular oversight and review of surgical caseload would align military trauma surgery with civilian standards. The benchmark set by the United States Department of Defense Trauma Registry should be replicated for Australian led combat operations and modified to facilitate interoperability to support future coalition combat operations.
此前尚未对澳大利亚国防军（ADF）成员在阿富汗“拖鞋行动”和“高速公路行动”中所受损伤的外科治疗进行全面回顾。了解损伤机制、所遭受的损伤类型以及采取的外科干预措施，应为未来的医疗规划和外科能力确定提供有价值的信息。
对通过伤亡登记册检查确定的受伤人员的扫描医疗记录进行回顾性图表审查。
2002年1月至2021年12月期间，有259名澳大利亚国防军人员在阿富汗受伤，其中53人受重伤（SI）或极重伤（VSI）。可查阅101名伤亡人员中90人的病历，包括那些受极重伤、重伤以及虽被归类为状况良好但可能需要手术和/或受伤后返回澳大利亚的人员。大多数极重伤/重伤患者需要手术（93%），且大多数人受伤后返回了澳大利亚（91%）。近三分之二（64.4%）的初次手术是在二级E类医疗设施（MTF）进行的。枪伤（GSW）是最常见的致伤机制（47%），其次是爆炸伤（39.6%）。骨科手术（32.2%）和软组织初次伤口手术（47.1%）是最常见的外科手术。
来自不同国家的多个外科团队在多个地点对军事创伤进行了外科治疗，取得了出色的成果，并符合损伤控制外科的现代原则。军事创伤系统与民用创伤系统截然不同，资产分散，需要在不同护理层级之间多次转移伤员，而不是集中在一级创伤中心。尽管如此，仍可取得优异的成果。加强沟通和文件记录渠道将增强军事创伤系统继续取得此类成果的能力，定期监督和审查手术病例数量将使军事创伤外科符合民用标准。美国国防部创伤登记处设定的基准应在澳大利亚主导的作战行动中复制，并进行修改以促进互操作性，以支持未来的联军作战行动。
