Mass casualty response of a modern deployed head and neck surgical team

BACKGROUND: The battlefields of the Global War on Terror have created unique demands on deployed surgical teams. Modern high-energy fragmentation devices often inflict complex head and neck injuries. This series analyzes the role of the head and neck surgical team during 3 separate single explosive events that led to civilian multiple casualty incidents (MCIs) treated at a military theater hospital in Iraq from February to April 2007. METHODS: All MCIs occurring between February and April 2008 with triage and treatment at the 332nd Air Force Theater Hospital in Balad, Iraq, were identified and reviewed. Injury Severity Score, admission injury pattern, length of hospital stay, head and neck procedures, non-head and neck procedures, and clinical duties performed by the otolaryngology surgeon were recorded and analyzed. RESULTS: Three MCIs occurring during the period of February to April 2008 were reviewed and described as incidents A, B, and C. A total of 50 patients were involved. Eighteen patients (36%) were treated for head and neck trauma. The average ISS for the non-head and neck trauma group was 15.8 (range, 1-43), whereas the head and neck trauma group average ISS was 23.6 (range, 2-75) (P andlt; 0.06). The most commonly performed head and neck procedures included repair of facial lacerations, maxillomandibular fixation, and operative reduction internal fixation of facial fractures. The head and neck surgeon also performed airway triage and assisted with procedures performed by other specialties. CONCLUSIONS: By reviewing 3 MCIs and the operative log of the involved otolaryngologist, this review illustrates how the otolaryngologist's clinical knowledge base and surgical domain allow this specialist to uniquely contribute in response to a mass casualty incident.