War Surgery in Afghanistan and Iraq: A Series of Cases, 2003–2007

Abstract

War is inherently bad for health. Over the centuries, however, war has proved to be a very valuable laboratory for advancing medical knowledge. Many of the current methods of managing wounds and other trauma, various infectious diseases, environmental exposures, and common health problems occurring in extreme environments—all of keen interest to wilderness medicine practitioners—have come from wartime experiences. The current wars in Afghanistan and Iraq are no exception. Medical knowledge has been advanced in the areas of hemorrhage control, compartment syndromes, brain injury, and other trauma; pain management; post-traumatic stress disorder; medical information management; and medical transport, among others. What is unprecedented, though, is the rate of learning. The combination of high-speed communications, practiced command and control, rapid evacuation, routine teleconferencing between medical care settings in the combat theaters and referral centers in the United States, and increased computer-based patient tracking is refining practice in near real time, and survival rates from previously mortal injuries have dramatically risen. War Surgery in Afghanistan and Iraq memorializes some of the lessons learned from these conflicts and exemplifies the rapidity with which medical lessons are being learned. Instead of its taking years after a war has ended for lessons learned to be compiled, this collection of case studies is being made available as the conflicts still rage. This large-format book is a compilation of 70 cases that begins with a prologue describing trauma system development and medical evacuation in the combat theatre. The cases are divided into 9 chapters focused on acute resuscitation and critical care; face, neck, and eye trauma; head and spine trauma; thoracic trauma; abdominopelvic trauma; soft-tissue trauma and burns; orthopedic trauma; vascular trauma; and special scenarios. Most of the chapters contain 6 to 8 illustrative cases. Each case follows a similar format: a case summary followed by discussion of the teaching points, clinical implications, damage control, a summary, and suggested readings. Appendices provide information on abbreviations and acronyms, product manufacturers, the Glasgow Coma Scale, and clinical practice guidelines. Perhaps the most notable feature of the book is its large number of color photographs, most of which were taken with hand-held digital cameras by treating physicians during the course of care. Readers not accustomed to dealing with severe trauma may find many of these disturbingly graphic. The book's text is clear and crisp, although the style does vary from chapter to chapter, as often occurs with multiauthored works. Overall, War Surgery in Afghanistan and Iraq is an exceptional book. I heartily recommend it to anyone seriously interested in wartime medicine, trauma care, surgery, or care for severe injuries in medically austere environments.