Nonconventional Uses of the Rocket-Propelled Grenade and Its Consequences

Military Medicine, Jun 2007 by Woebkenberg, Brian J, DeVine, John G, Rush, Robert, Starnes, Benjamin, Stinger, Harry

Operation Iraqi Freedom and Operation Enduring Freedom have forced U.S. and allied medical personnel caring for wounded soldiers to reassess nonconventional uses of the rocket-propelled grenade. The effects can be devastating when this device is used as an antipersonnel weapon, producing large blast injuries that are limb and life threatening. A classic case presentation followed by a short historical perspective on the rocket-propelled grenade and a proposed algorithm for initial care of these wounds is presented.

Introduction

There is a paucity of reports on dealing with wounds sustained by rocket-propelled grenades (RPG). Due to the increasing role of U.S. troops in Middle East operations, these injuries are increasing in number. Injuries related to its use and their treatments have become an important question to medical personnel who care for these injured soldiers. We present a 26-year-old male with an extremity injury sustained from an RPG and his treatment. We further describe the nature of the RPG, its initial intended uses, and the implications of fighting and defending this type of weapons system. A treatment algorithm for this soldier as well as others sustaining these types of injuries is proposed.

case Report

A 26-year-old male presented with a blast injury to the right thigh from a RPG (RPG-7). The patient had been reported to have sustained "significant blood loss" in the field and attempts at controlling hemorrhage with a tourniquet had been unsuccessful. He was the lone injured soldier in this particular blast. On presentation to the forward surgical team, the patient had a Glasgow Coma Score of 14, systolic blood pressure of 80 mm Hg, and hematocrit of 30. Physical examination revealed grossly contaminated, circumferential soft tissue injury to the thigh with active bleeding. The patient had a comminuted mid-shaft femur fracture as his isolated injury. The extremity distal to the injury was insensate and without a pulse (Fig. 1). The patient was in class 3 shock and had a Mangled Extremity Score of 9.

Resuscitation was initiated on arrival and the patient was emergently taken to the operating room (OR) for exploration, hemorrhage control, and debridement. In the OR, the limb was found to be nearly amputated with only a small skin and subcutaneous soft tissue bridge posterior and medially (Fig. 2). The neurovascular structures, which had been severed, were Iigated. The traumatic above-the-knee amputation was completed and obvious devitalized soft tissue was debrided until bleeding muscle was encountered (Fig. 3). The wound was then dressed with saline-soaked gauze and an anterolateral skin flap was used as a biologic dressing to cover the distal aspect of the wound (Figs. 4 and 5). The wound was then irrigated with 20 L of normal saline using a pulsatile lavage. Broad-spectrum antibiotics were administered. Intraoperative resuscitation required 12 units of packed red blood cells, 5,000 ml of crystalloid, and 500 ml of hespan. The patient was extubated and remained stable until evacuation from the theater 12 hours postoperation. In total, this patient required 3 hours of surgery time between two surgeons: the orthopaedic surgeon and the assisting general surgeon. This patient was evacuated to higher echelons of care after being stabilized and follow-up information was not available.

Discussion

The RPG was developed in May 1958 after a decree from the Soviet Union Council of Ministers.12 The RPG is a direct descendant of the World War II German Panzerfaust. Developed initially as an antitank grenade launcher, it still functions primarily as an antiarmored vehicle weapon, but advancements have been made to broaden its capabilities to include the ability to fire specialty rounds for illumination, smoke screens, tear gas, white phosphorus, fuel-air explosive, fragmentation rounds, a thermobaric warhead (comparable in efficiency to a 120-mm artillery projectile), antitank rounds capable of penetrating 600 mm of rolled homogenous steel, and the tandem warhead designed to penetrate explosive reactive armor and the armor underneath.1-3

The RPG has the capacity to engage and destroy moving targets at 300 m and stationary targets at 500 m. The maximum range of the antitank rounds is 920 m and the antipersonnel grenades are 1,100 m based on the 4.5-second flight time and the self-destruct mechanism at the conclusion of the flight.2 The weapon is a shoulder-fired, muzzle-loaded grenade launcher, which weighs approximately 15.2 Ib (Fig. 6). The weapon has a lethal blast radius of 4 m when used as an antipersonnel weapon killing with blast and debris.1"3

The continued use of this lightweight highly mobile weapon has been seen since its initial development. It is currently used by more than 40 countries. Besides Russia, the following countries are licensed to manufacture this weapon: Bulgaria, China, Iran, Iraq, Romania, and Pakistan.2 The Soviet-Afghan War lasted 10 years and during this time the Mujahideen refined the techniques used with this weapon. These fighters used this weapon against vehicles, personnel, and helicopters. The U.S. Army Blackhawk helicopters encountered similar antihelicopter tactics in Somalia through "helicopter ambushes."1"3