Lethal Injuries among the Members of the 4th Guardian Brigade of Croatian Army during the 1991-1995 War

Military Medicine,  Apr 2004  by Situm, Mirna,  Milinovic, Ivo,  Poje, Gorazd,  Bucan, Zeljana,  Ozanic-Bulic, Suzana

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Objective: We analyzed the causes of deaths among the members of the 4th Guardian Brigade (GB) of the Croatian Army during the war in Croatia from 1991 to 1995: the site of the lethal injuries, the type of wounds, and estimated the severity of injuries with lethal outcome according to the Abbreviated Injury Scale. Methods: This was a retrospective study using the files and data obtained from 4th GB, Croatian Ministry of Defense, and Croatian Ministry of War Veterans. Results: During the War in Croatia from 1991 to 1995, 182 members of 4th GB were killed. One hundred fifteen (63.2%) suffered lethal injuries caused by shell fragments, 47 (25.8%) soldiers had gunshot wounds, and 20 (11.0%) died in traffic accidents. Mean Abbreviated Injury Scale for killed soldiers was 7.61 ± 1.27.

Conclusion: During the war in Croatia, the leading causes of death were mines and explosions, and, in a minor proportion, gunshot wounds.

Introduction

In April 1991, Serbian paramilitaries attacked Croatian police at Plitvice. Thus, the war in Croatia began. " The most difficult year, according to the intensity of destruction with the highest number of killed people and refugees, was 1992. The war ended in August 1995. The 4th Guardian Brigade (GB) that participated in all war activities in Southern Croatia was established in the spring of 1991 as a professional military unit. Many of its members were killed on the front lines.

Multiple injury is the leading cause of death among young people.4'5 For example, more than 50% of total mortality in people ages 15 to 35 in Croatia in 1992 was due to multiple injury. We decided to analyze the causes of death in one professional unit of the Croatian Army during the 1991-1995 war. We studied the site of lethal wounds and the type of injury (e.g., explosions from mines, shrapnel, and bullet wounds).

Methods

Background

Volunteers established the 4th GB of the Croatian Army on April 28, 1991. At first, it was an infantry brigade with no heavy weapons and was more similar to a police unit. The brigade was composed of four battalions (1st Split, 2nd Sinj, 3rd Imotski, and 4th Drnis) with soldiers from different parts of Southern Croatia. This brigade passed through all battlefields in the south of Croatia. In August 1991, the first defense activities started in the Zadar hinterland, Drnis, Sinj border (Vrlika and Hrvace), and around the Dubrovnik area (Imotica and Topolo). During 1992. the 5th infantry battalion was formed, and the brigade war armed with artillery. In the same year, the brigade performed its first offensive activities on the Dubrovnik battlefield, which succeeded in liberating the Konavli area. In January 1993. the 4th GB performed the action "Maslenica" that unblocked Zadar and connected Northern and Southern Croatia, which had been separated a year before by enemy forces, by an improvised bridge. In the summer of 1993, the brigade performed an active defense of the Sibenik hinterland (Stankovci, Gaceleze, and Raslina) that decreased artillery attacks on the city of Sibenik. In 1994, the brigade was active on the Sinj battlefield and they prevented enemy attacks against Middle Dalmatia. In extremely difficult winter conditions, fighting against nature high in the mountains with epidemic hemorrhagic fever, during the action "Winter," the military-strategic targets were achieved before the spring of 1995. In 1995 from May to july, the 4th GB performed actions "Jump I" and "Jump II," secured the borders, and prepared for the final liberation of Knin. In August of 1995, the 4th GB participated in the action called "The Storm" when Croatian armed forces liberated most of the occupied Croatian territory. During this action, our Army fought side by side with the Bosnian Army. The 4th GB also took an active part in actions "Landward Breeze" and "South Stroke," which were performed on the territories of Glamoc, Sipovo, Jajce, and Mrkonjic Grad in Bosnia-Herzegovina. From 1992, a brigade consisted of 2,500 soldiers and was armed with additional infantry weapons.

A medical corps was established from the start, with doctors, medical technicians in battalions, nurses, and other medical staff. By 1995, the brigade had 10 doctors, 1 dentist, and 33 technicians. From 1991 to 1995, an ambulance was used on all battlefields and, occasionally, speedboats and/or helicopters were used.

Sources of Data

We used the 4th GB files (war medical protocols, death certificates, nonmedical files from the Command and Care Service of Brigade, and war diaries) and the documentation of Ministry of Defense and Ministry of Croatian War Veterans.

Evaluation of Injuries

This retrospective study was based on 181 deaths in the 4th GB from 1991 to 1995. The severity of injures was estimated according to the Accidental Injury Scale (AIS).6 AIS measures a single lethal trauma with grades from 6 to 9. AIS 6 stands for lethal injury of one region with concomitant injuries of three or more other anatomical regions. AIS 6 also stands for lethal burns regardless of their severity. AIS 7 stands for lethal injury of one region followed by five more other regions. In the case of AIS 6 or 7, death occurs within 24 hours. AIS 8 stands for two lethal injuries of two different anatomical regions, and AIS 9 means three or more lethal injuries. AIS 9 also stands for total body carbonization caused by fire.