Modern publications on response to single explosive events are from non-US hospitals, predate current resuscitation guidelines and lack detail on surgical and intensive care unit (ICU) requirements. The objective of this study is to provide a contemporary account of surge response to multiple casualty incidences following explosive events managed at a US trauma hospital in Iraq.
Observational study and retrospective chart review of 72-hour transfusion, operating room, and ICU resource utilization from 3 multiple casualty incidences managed at the US Air Force Theater Hospital, Balad AB, Iraq between February and April 2008.
Fifty patients were treated with a mean injury severity score of 19. Forty-eight percent (n = 24) of casualties required blood transfusion with 4 patients receiving 43% (N = 74 units) of the packed red blood cells (pRBC). An average of 3.5 and 3.8 units of pRBC and plasma, respectively, was transfused per casualty (pRBC:plasma ratio of 1:1.1). Seventy-six percent (n = 38) of patients required immediate operation upon initial presentation. A total of 191 procedures were performed in parallel during 75 operations (3.8 procedures per casualty). Fifty percent (n = 25) of patients required ICU admission with nearly the same number (n = 24) requiring mechanical ventilator support beyond that required for operation. All cause, in-hospital mortality was 8% (n = 4).
Results from this study provide a contemporary assessment of transfusion, surgical, and intensive care resource requirements after a single explosive event. Data from this experience may translate into useful guidelines for emergency planners worldwide.
This study provides a contemporary account of a resource surge response to multiple casualty incidences following explosive events managed at a US trauma hospital in Iraq. Results from this study provide a contemporary assessment of transfusion, surgical, and intensive care resource requirements following a single explosive event. Data from this experience may translate into useful guidelines for disaster emergency planners worldwide.
From the *The 332nd Expeditionary Medical Group/Air Force Theater Hospital Balad Air Base, Iraq; †Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, TX; ‡Trauma, Burn, and Surgical Critical Care Program, Bronson Methodist Hospital, Kalamazoo, MI; and §The Uniformed Services University of the Health Sciences, Bethesda, MD.
The views expressed in this report are those of the authors and do not reflect the official policy of the Department of Defense or other departments of the US Government.
Reprints: Todd E. Rasmussen, MD, FACS, Division of Surgery, Wilford Hall USAF Medical Center, Lackland Air Force Base, TX 78236. E-mail: firstname.lastname@example.org.