Introduction and epidemiology

Penetrating missile wounds, injuries from blast phenomena and burns are the typical features of modern conventional war. This chapter is concerned only with missile wounds and blast injury. Burn injury is covered in Chapter 14. Missile wounds are caused by bullets or by fragments from exploding shells, mines or bombs. Exposure to blast phenomena may result in unique and complex injury patterns, and these will be described.

There is a wealth of data on the cause and distribution of wounds in wars over the last 30 years. Care is needed in interpretation as the number of wounded varies greatly in each series. For example, Vietnam data cover over 17 000 casualties. In contrast, Gulf war data are restricted to 63 casualties, Inclusion criteria are also very variable and many fail to record multiple injuries to different body systems in single casualties — the hallmark of modern war injury. Tables 19.1,19.2 and 19.3 summarise the available data.

While care is needed in interpreting the available data, some broad statements concerning war injury can be made. The most common wounding agent in surviving casualties is a fragment wound, not a bullet wound as many erroneously believe. Limb injuries predominate, pointing to the high lethality of hits to the trunk and head. The most startling revelation is the emerging incidence of multiple hits to mul­tiple body regions in survivors. This is a deliberate policy —the aim in modern war is to incapacitate, not kill. The reason is clear: large numbers of surviving casualties are a major financial and logistic burden on a nation engaged in total war.

In conclusion, the factors that govern the nature, severity and outcome of a war wound are many and include the weapon systems deployed, the environment in which the weapon systems are deployed, and the quality and timing of medical management. In short, there is no single entity that merits the description ‘the war wound’.