The roadside bomb in Iraq: Emerging patterns of injury

Abstract

Background: Following the invasion of Iraq in April 2003, Coalition forces have been conducting counter-insurgency operations in a bid to maintain security within in the country. The roadside bomb or improvised explosive device (IED) has become the weapon of choice of the terrorist and is the leading cause of death and injury amongst coalition troops in the region. Method: From January to October 2006, data was collected on all casualties who were injured or killed by an IED. Mechanism of injury, new Injury Severity Score (NISS), anatomical pattern of wounding, operative management and 1-year follow-up was recorded in a trauma database. Results: Fifty-three casualties were injured by IEDs in 23 incidents (mean 2.3 casualties per incident). Twelve (22.6%) were killed or died of wounds. Mean NISS score of survivors was 5.4 (range 1-50). A mean 2.78 body regions were injured per casualty. Limb injuries were present in 45 (84.9%) of casualties, but primary blast injuries were seen in only 9 (14%). Conclusions: IEDs do not follow the traditional pattern of injuries as seen from conventional explosives. Primary blast injuries were minimal despite all casualties being in close proximity to the explosion. The explosive formed projectile (EFP) appears to cause catastrophic injuries to casualties caught in its path, but causes relatively minor injuries to personnel sited adjacent to its trajectory. Improved vehicle protection may prevent the EFP from entering the passenger compartments and thereby reduce coalition troop fatalities.