Surgical response to multiple casualty incidents following single explosive events

Brandon W. Propper, Todd E. Rasmussen, Scott B. Davidson, Sheri L. Vandenberg, W. Darrin Clouse, Gabe E. Burkhardt, Shaun M. Gifford, Jay A. Johannigman

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Background: 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. Methods: 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. Results: Fifty patients were treated with a mean injury severity score of 19. Forty-eight percent (n = 24) of casualties required blood transfusion with 4 pat ents 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). Conclusions: 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.

Original languageEnglish
Pages (from-to)311-315
Number of pages5
JournalAnnals of surgery
Volume250
Issue number2
DOIs
StatePublished - Aug 2009
Externally publishedYes

Keywords

  • Explosive devices
  • Mass casualty
  • Transfusion
  • Trauma surgery

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