Surgical response to multiple casualty incidents following single explosive events

Ann Surg. 2009 Aug;250(2):311-5. doi: 10.1097/SLA.0b013e3181ae34a2.


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 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).

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.

MeSH terms

  • Blast Injuries / epidemiology
  • Blast Injuries / therapy*
  • Blood Transfusion / statistics & numerical data
  • Cohort Studies
  • Critical Care / statistics & numerical data
  • Explosions*
  • Hospitalization / statistics & numerical data
  • Hospitals, Military*
  • Humans
  • Iraq War, 2003-2011*
  • Mass Casualty Incidents*
  • Retrospective Studies
  • Surgery Department, Hospital / statistics & numerical data*
  • Surgical Procedures, Operative / statistics & numerical data