Der Unfallchirurg

, Volume 113, Issue 2, pp 106–113

Verletzungsmuster und -ursachen in modernen Kriegen

  • R. Lechner
  • G. Achatz
  • T. Hauer
  • H.-G. Palm
  • A. Lieber
  • C. Willy
Leitthema

Zusammenfassung

Epidemiologische Analysen von Verletzungsmustern und -mechanismen sind von Interesse, um daraus fachliche Anforderungen an den vor Ort agierenden Chirurgen, Weiterbildungskonzepte und die erforderliche Infrastruktur abzuleiten. Hierfür wurden eine Medline-Recherche (1949–2009) (Stichwörter „combat“, „casualties“, „war“, „military“, „wounded“, „neurosurgery“), „Google-Suchläufe“ im worldwide web sowie eine Datenanalyse der im Afghanistan- und Irakkonflikt verstorbenen alliierten Soldaten durchgeführt. Im Irakkonflikt starben bisher 4688 alliierte Soldaten, im Afghanistankonflikt 1538 (Stand 10.12.2009). Hiervon verstarben 22% der Soldaten ohne Feindeinwirkung, 33% unmittelbar bei Kampfhandlungen und die Mehrheit von 45% durch indirekte Kampfhandlungen. Die Hauptverletzungsursachen sind Sprengsätze (70%) und Schussverletzungen. Haupttodesursachen sind bei den in Kampfhandlungen getöteten Soldaten („killed in action“) Verletzungen des Körperstamms (40%) und Schädel-Hirn-Verletzungen (35%). Im Irakkrieg beträgt die „case fatality rate“ annähernd die Hälfte des Vietnamkriegs. Die „Killed-in-action“-Rate in Afghanistan ist mit 18,7% ähnlich der im Vietnamkrieg (20,0%). Im Gegensatz dazu zeigt sich jedoch eine Verdoppelung der Amputationsrate. Etwa 8–15% der tödlich endenden Verletzungen erscheinen überlebbar.

Der Militärchirurg muss ein breites Feld der Chirurgie kompetent abdecken: lebensrettende Notfallmaßnahmen, v. a. im Bereich der Thorax-, Viszeral- und Gefäßchirurgie sowie praktische Fähigkeiten im Bereich der Neurotraumatologie und Mund-Kiefer-Gesichts-Chirurgie. Für den Therapieerfolg ist die ausreichende Bereithaltung von taktischem und strategischem „medical evacuation“ (MedEvac) für den Verwundetentransport von wesentlicher Bedeutung.

Schlüsselwörter

Kriegsverletzung Militärchirurgie Verwundung Verletzung Verletzungsmuster 

Patterns and causes of injuries in a contemporary combat environment

Abstract

Epidemiological analyses of injury patterns and mechanisms help to identify the expertise military surgeons need in a combat setting and accordingly help to adjust infrastructure and training requirements. Therefore, a MEDLINE search (1949–2009), World Wide Web search (keywords “combat, casualties, war, military, wounded and neurosurgery”) and an analysis of deaths among allied war casualties in Afghanistan and Iraq were performed. Up to 10th December 2009 there had been 4,688 allied military deaths in Iraq and 1,538 in Afghanistan. Of these 22% died in non-hostile action, 33% in direct combat situations and the majority of 45% in indirect combat actions. The leading causes of injury were explosive devices (70%) and gunshot wounds. Chest or abdominal injuries (40%) and traumatic brain injuries (35%) were the main causes of death for soldiers killed in action. The case fatality rate in Iraq is approximately half that of the Vietnam War, whereas the killed-in-action rate in Afghanistan (18.7%) is similar to the Vietnam War (20%); however, the amputation rate is twice as high in modern conflicts. Approximately 8–15% of the fatal injuries seem to be potentially survivable.

Military surgeons must have an excellent expertise in a wide variety of surgical specialties. Life saving emergency care, especially in the fields of thoracic, visceral and vascular surgery as well as practical skills in the fields of neurosurgery and oral and maxillofacial surgery are required. Additionally, it is of vital importance to ensure the availability of sufficient tactical and strategic medical evacuation capabilities for the wounded.

Keywords

Combat injuries Military surgery Wounds Injuries Injury pattern 

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Copyright information

© Springer Medizin Verlag 2010

Authors and Affiliations

  • R. Lechner
    • 1
  • G. Achatz
    • 1
  • T. Hauer
    • 1
  • H.-G. Palm
    • 2
  • A. Lieber
    • 3
  • C. Willy
    • 4
  1. 1.Klinik für Unfallchirurgie und Orthopädie, Chirurgisches ZentrumBundeswehrkrankenhaus UlmUlmDeutschland
  2. 2.Medizinisches ControllingBundeswehrkrankenhaus UlmUlmDeutschland
  3. 3.Abteilung Allgemein-, Viszeral-, Gefäß- und ThoraxchirurgieBundeswehrkrankenhaus BerlinBerlinDeutschland
  4. 4.Chirurgisches ZentrumBundeswehrkrankenhaus UlmUlmDeutschland

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