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
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’.