Israeli Army Casualties in the Second Palestinian Uprising

Military Medicine, May 2005 by Lakstein, Dror, Blumenfeld, Amir

This study analyzes the pattern of injuries and evacuation in this unique low-intensity conflict with many casualties and high availability of medical services and evacuation means. Injury data regarding Israel Defense Forces casualties during the first 19 weeks of the events were collected and analyzed. Ninety-six of the 356 Israel Defense Forces casualties during the first 4 months of the events were admitted or killed. Bullets (63.5%) were the most common cause of injury. Fragments and explosives accounted for 14.6% of injuries, stones and sling-thrown marbles accounted for 9.4% of injuries, and 12.5% of injuries were from miscellaneous causes. The most commonly injured body regions were the head, face, and neck (54.2%) and the limbs (50.0%). The trunk was injured in 25.0% of cases, and 4.2% of injuries were classified as external. Injury severity distribution was bimodal. The largest group represented patients with Injury Severity Scores (ISSs) between 1 and 14. The other large group was the 23 dead soldiers. The group of soldiers with ISSs between 16 and 75 included five patients only. Sixteen of the 23 dead soldiers were killed in action. Seven soldiers died of their wounds in the hospital, four of them within the first hour after admittance. A total of 83.8% of the casualties were evacuated by ambulances and the rest were evacuated by air. All casualties except one reached the hospital within 1.5 hour after the injury. Seventy-five percent of the injured were evacuated to trauma centers, and the rest were evacuated to other hospitals. The group of soldiers evacuated to trauma centers had a significantly (p = 0.021) higher mean ISS. The nature of this conflict resulted in a bimodal distribution of injuries. Most of the soldiers were either mildly injured or killed, whereas relatively few suffered severe injuries. The prehospital medical forces should be able to identify such patients and provide prompt treatment and evacuation. The abundance of head, face, neck, and limb injuries suggests that the current armor systems should be further investigated and improved.

Introduction

We describe the epidemiologic features of injuries sustained by Israeli soldiers in the first 19 weeks of the events that occurred in the West Bank, the Gaza Strip, and northern Israel and started September 27, 2000. This conflict, referred to by the Palestinians as the "Al-Aqsa Intifada," combined riots of the civilian population with low-intensity military conflict between the Israel Defense Forces (IDF) and the Palestinian Armed Forces. Data for this report, collected both in the field and in the hospitals, included detailed information on the causes of injuries, evacuation, and diagnoses and enabled analysis of injury severity and mechanism, for both the soldiers who died and those who survived.

Conflicts combining limited military ability with civilian involvement were reported before and were usually characterized by evacuation difficulties and long distances from established medical centers. This conflict was characterized by the close proximity and high level of availability of military medical and emergency medical services staff, including well-trained physicians and paramedics. In addition, good accessibility of evacuation means (both air and ground transportation) and proximity to medical centers shortened the evacuation times. The IDF's military staff is trained and equipped to consider both "scoop and run" and "stay and treat" approaches. Decisions should be made considering the injuries and the objective environmental conditions. Flexibility is the major issue. In the current conflict, junior medical personnel, their commanders, and professional advisors learned, through an ongoing process of learning, that the most appropriate approach in most cases would be to perform immediate limited life-saving procedures, followed by prompt evacuation to a trauma center.

The purpose of this study was to investigate the properties of injuries in this unique situation. This information is essential for proper medical staff preparations and armor design for future events. Demonstration of similarities and differences between conflicts, as reflected in the distribution of injuries, highlights the significance of these data.

Methods

Injury data regarding IDF soldiers who were wounded or killed during the disturbances that occurred in the West Bank, Gaza Strip, and northern Israel between September 27, 2000 and February 5, 2001 were collected. Only soldiers who were either killed or injured severely enough to be admitted to the hospital were included. Soldiers who were treated only in the field or were discharged after examination and treatment in the emergency department were excluded. The latter group can be referred to as "carded for record only."1

The data were collected from various sources, including reports from field medical officers and medics, air evacuation medical reports, hospital medical records, and postmortem examination reports. Designated military representatives at the hospitals filled in questionnaires, at admission, with information about injury circumstances, weapons involved, evacuation, and emergency department diagnoses. A computerized database was established, and data from all of these sources were entered.