Protecting Military Convoys in Iraq: An Examination of Battle Injuries Sustained by a Mechanized Battalion during Operation Iraqi Freedom II

Military Medicine, Jun 2005 by Gondusky, Joseph S, Reiter, Michael P

Improvised explosive devices and mines pose a formidable threat to military convoys traveling in Iraq. This study evaluated battle injuries sustained by a mechanized battalion operating against this threat. The objective was to gain insight into injury profiles and prevention. In the period examined, 32 attacks injured 120 Marines, causing 188 injuries. Upper extremity and head injuries (70%) were common, whereas lower extremity injuries (11%) were rare (as expected, given the threat and the body areas exposed). Shoulder and axilla protectors may be beneficial, but lower arm and hand injuries remain difficult to combat. Ear injury was the most common single injury type (23%). Combat earplugs may reduce ear blast injuries. Eye injuries were uncommon (0.5%), likely because of ballistic eye protection. Injury to the torso (11%) was generally mild, because of body armor vests. The majority of wounds were minor, allowing >80% of the injured Marines to return to duty.

Introduction

This study is an evaluation of battle injuries sustained by the 1st Light Armored Reconnaissance (LAR) Battalion in March through August 2004, during operations in support of Operation Iraqi Freedom II. The battalion's primary threats during this period were attacks with improvised explosive devices (IEDs) and mines. The study aims to provide useful data for military units expecting to operate in similar threat environments. With these injury data, medical providers can gain insight into expected injury distributions, casualty rates, and methods of injury prevention. The results are particularly applicable to mechanized battalions.

The 1st LAR Battalion is a mechanized battalion within the 1st Marine Division. The battalion deployed with approximately 950 personnel, divided into three line companies and a headquarters and services company. The line companies are fully mechanized and travel in first-generation light armored vehicles (LAVs) (Fig. 1). Each line company contains approximately 25 LAVs. LAVs come in different variants with similar exterior armor protection and carry an average of six personnel. The headquarters and services company is less mobile and travels in a mixture of LAVs, highly mobile multiwheeled vehicles, and trucks.

The battalion saw moderate activity in western Iraq and operated around the Fallujah area in April 2004. The battalion traveled extensively during the deployment, logging an average of ~9,000 km per LAV during the period examined. A small battalion detachment based in Ar Ramadi saw significant activity during the period.

Patient care in the battalion is the responsibility of the battalion aid station medical staff, consisting of an internshiptrained general medical officer, an independent duty corpsman, and 35 junior corpsmen. Initial medical care at the scene is frequently performed by a junior line corpsman attached to the company. In our area of operation, patients requiring medical evacuation were most often evacuated from the scene to a level II forward resuscitative surgical system/shock trauma platoon in theater by Army medical evacuation crews.

Methods

Battalion battle injury data from March through August 2004 were analyzed. All statistics came from LAR battalion aid station and 1st Marine Division patient tracking data. The numbers of wounded in action (WIA) and killed in action (KIA) were tabulated by month. Patients considered WIA were those who presented for medical care after an incident with a related abnormal examination finding. WIA patients were divided into returned to duty (RTD) and evacuated groups. RTD patients were those who returned to full duty during the deployment, either immediately after the incident or after a period of light duty. The length of light duty is reported for RTD Marines and signifies recovery time required from the incident to full duty status. Evacuated patients required transfer to the continental United States (CONUS) for continued care. Injury distributions and causes are also reported.

Results

For the period examined, 125 patient-events were reported (some patients were RTD but were subsequently reinjured). The 125 patient-events consisted of 120 WIA and five KIA cases. WIA cases increased throughout the period examined (Fig. 2). The KIA rate for the period was 0.03 deaths per 1,000 troops per day.

The injuries sustained were the result of 32 separate attacks on the battalion. Ninety-seven percent of patients were injured by IEDs (65%) or mines (32%). The rest of the injuries resulted from direct fire (3%) (Fig. 3). All of the injured patients were Marines riding in LAVs, except for five who were passengers in highly mobile multiwheeled vehicles. The average number of Marines injured or killed from an event was 3.9 (range, 1-9 Marines). Injuries per Marine averaged 1.6 (range, 1-4 injuries per person).

Injury sites among the WIA are shown in Figure 4. Fifty-three percent of injuries were to the head and neck. Twenty-two percent of injuries were to the upper extremities. Torso (11%) and lower extremity (11%) wounds were most commonly soft tissue injuries. Rates of injuries to the pelvis (2%) and abdomen (3%) were low. Eye injuries accounted for 0.5% of total injuries. Total ear injuries constituted 23%. Tympanic membrane rupture alone accounted for 4% of total injuries, with an incidence of 7% among the wounded.

Exact diagnoses for the battalion KIA were not obtained. These individuals suffered combinations of severe orthopedic and torso trauma or devastating head injuries. Evacuated patients expectedly sustained the most serious wounds among the WIA. Their injuries mirrored those of the battalion KIA but were less severe. Of the 17 patients who required evacuation to CONUS, seven had upper extremity fractures or shrapnel injuries, and three had severe head injuries. One of the patients with a severe head injury also sustained an abdominal injury requiring laparotomy and splenectomy. Three WIA individuals suffered lower extremity shrapnel injuries or fractures. The rest of the injuries requiring evacuation included rib fracture, buttock shrapnel, mandibular fracture, and back shrapnel injuries.