1 in 6 Combat Wounded in Iraq, Afghanistan Need Treatment by Otolaryngologists
One of the characteristics of military medicine is its provision of medical care by echelon, or level. Level I care occurs on the battlefield, and is usually provided to a casualty by a buddy or a medic. Level II care occurs at the level of the medical company of the brigade or division. Level III is a theater-deployed hospital. Level IV is overseas sustaining fixed facility tertiary care medical centers. Landstuhl Regional Medical Center (LRMC) at Ramstein Air Force Base (AFB) in Southwest Germany is the only Level IV facility outside the United States offering definitive care for combat forces in Iraq and Afghanistan.
Landstuhl, a 20-building hospital complex, has a normal bed capacity of 162, yet increased to over 322 prior to the beginning of the war. This facility has accepted the vast majority of casualties from both Operation Iraqi Freedom (OIF)/ Operation Enduring Freedom (OEF). From Landstuhl, patients are then air-evacuated predominantly to Walter-Reed Army Medical center or Bethesda Naval Medical Center in Washington, D.C. Additional patients are sent to Wilford Hall Air Force Medical Center in San Antonio, Texas. However, most of the OIF/OEF soldiers are definitively treated in Germany then returned to duty downrange in Iraq or Afghanistan.
Currently, there are no ((ENT))-head and neck surgeons assigned in either the Army Combat Support Hospitals (CSH) or the Air Force Expeditionary Medical Support (EMEDS) mobile hospitals. Therefore, no ENT surgeon is currently tasked to deploy to a level under Level IV echelon of care. Therefore, the first place that an injured or ill combat service member will see an ENT surgeon is as a result of evacuation out of theater to a Level IV facility in Germany.
Two military surgeons, experienced in treating the wounded from Iraq and Afghanistan, elected to observe a one year window of combat operations with an additional two month window (01 January 2003 to 19 March 2004) to obtain a study population By examining the ENT-related diagnoses of all air evacuations from downrange, they were able to calculate the percentage of air-evacuated patients evaluated by the ENT (ear, nose, and throat) service at Landstuhl. They were also able to calculate the total number of overlapping ENT diagnoses evaluated by all other medical services at Landstuhl.
The authors of "Analysis of Battlefield Head and Neck Injuries in Iraq and Afghanistan, are Lt. Col. Michael S. Xydakis, MD USAF (MC), then assigned at Landstuhl Regional Medical Center in Germany; Col. John D. Casler, MD, USA (MC), Chief Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC; Maj. Michael D. Fravell, MSHI, USAF, Chief Information Officer and Katherine E. Nasser, also at Landstuhl Regional Medical Center. Their study, designed to assist in the development of a contemporary basis for modeling and operational planning for medical personnel allocation in a combat theater of operations, will be presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.
Methodology: To examine the designated review period, the researchers constructed a new computer patient tracking system at LRMC (DWMCC PIA), which merges several disparate databases to generate and compile the data. A prospective review of patients air-evacuated from Afghanistan and Iraq was performed. More than 11,287 patients were air-evacuated to LRMC. The researchers identified the total number of ICD-9 diagnoses that would typically be seen by an ENT surgeon at a U.S. tertiary care major medical center. They then matched 739 ENT-related ICD-9 codes against all patients brought to the Air Force medical facility.
Results: Landstuhl Regional Medical Center received and managed 11,287 patients in the 14- month time frame of this study. The vast majority of these patients were from Operation Iraqi Freedom (OIF) and most patients were seen in an outpatient setting. Casualty status as reported in the TRACES air-evacuation databank at Ramstein revealed that 22 percent of all patients (2,483 patients) air-evacuated to Landstuhl were classified as "Battle Injuries."
Some 8.7 percent of all air-evacuated patients out of theater to Germany were evaluated and managed primarily by the ENT department. Another 7.3 percent of all patients evacuated out of theater with overlapping ENT diagnoses were managed by other medical and surgical services. Therefore, the number of potential ENT patients rises to 16 percent when one looks at all head and neck pathology seen by all medical and surgical departments hospital wide.
Of the total number of patients managed by the ENT department, one in six (16 percent) were trauma patients. The percentage of traumatic head & neck wounds managed by services other than ENT was 44.4 percent. Approximately five percent of all patients air-evacuated to LRMC for any condition were managed for head & neck trauma. However, 21 percent of all patients classified as having "Battle Injuries" presented with at least one head & neck trauma code.
Conclusions: The authors suggest that improved body armor and emerging enemy tactics have resulted in a distinctly new pattern of combat injuries. Ballistics researchers' and developers concerns have responded by protecting personnel from fragments through the development of light, effective body armor. The consequence has been enhanced body protection has resulted.
At the same time, these findings reveal that the facial and neck regions as well as the extremities remain exposed. Wounds to unprotected areas of the body account for the majority of injuries. Fortunately, extremity injuries are generally not fatal. On the other hand, wounds to unprotected regions of the head and neck account for the majority of combat deaths.
The development of solid armored plates worn in addition to soft-body armor effectively prevented most projectiles from entering the chest and upper abdomen. Now, future planning of body protection needs and medical support for combat casualties should reflect this new pattern of battlefield injury. The question of whether or not an ENT surgeon should be an integral part of a deployed combat surgical hospital should be considered.
The authors of this study state that the views and opinions contained in this research study are their private views and are not to be construed as official or reflecting the views of the Department of the Army, Air Force, or Defense.
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1 din 6 Combaterea Rãnit în Irak, Afganistan necesitã tratament de Otolaryngologists - 1 in 6 Combat Wounded in Iraq, Afghanistan Need Treatment by Otolaryngologists - articole medicale engleza - startsanatate