Amputation trends in military personnel during the israel-hamas war in 2023-24.

OBJECTIVE

To characterize the mechanisms, distribution, and outcomes of traumatic limb amputations among military casualties during the Israel-Hamas War, and to evaluate the association between life-saving interventions and survival.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study analyzed data from the Israel Defense Forces Trauma Registry. The cohort included 3253 urgent battlefield casualties who sustained limb injuries and were treated by IDF medical forces between October 27th, 2023 and October 31st, 2024.

MAIN OUTCOMES AND MEASURES

The primary outcomes were anatomical distribution of amputations, mechanism of injury, application of life-saving interventions (tourniquet, whole blood, freeze-dried plasma), and survival on the way to hospital admission and during hospitalization.

RESULTS

Of 3253 casualties, 135 (4.2 %) were initially recorded as having amputations. After review, 112 cases were confirmed to involve at least one amputated limb. Explosive devices were the leading cause of injury among amputees (88.9 %). Among the 112 confirmed cases, 50 (44.6 %) survived until hospital admission, and 62 (55.4 %) were pronounced dead prior to hospital arrival; 4 of the survivors died during hospitalization. Tourniquets were applied in 90 % of survivors compared to 24.2 % of deceased (p < 0.001). Whole blood and FDP were administered more frequently in survivors (60 % and 40 %, respectively) than in deceased casualties (9.7 % and 4.8 %, respectively; p < 0.001 for both). Above-knee amputations were the most common anatomical level in both groups.

CONCLUSION AND RELEVANCE

Combat-related limb amputations during the Israel-Hamas War were primarily caused by explosions and were associated with high mortality. Prompt application of life-saving interventions, particularly tourniquets and early blood resuscitation, was strongly associated with survival. These findings emphasize the critical need for rapid hemorrhage control and trauma care readiness in modern military conflict settings.