Management of High-velocity Firearms Injury in Counterinsurgency Area: A Single-Center Study

Abstract

Background: High-velocity firearms injuries in counterinsurgency (CI) areas are different from civilian injuries in terms of mechanism of injury, pathophysiology, management, and outcome. Hostile environments and difficult terrain are the main roadblocks in providing quality first aid and timely evacuation, which leads to compromised outcomes. This study was designed to analyze the epidemiology, management modalities, and complications of firearm injuries referred to a trauma care center in a counterinsurgency (CI) area. Methodology: This is a single-center prospective observational study over 3 years at a trauma care hospital in the Union Territory of Kashmir in India. All patients with firearm injuries sustained during CI operations were part of the study cohort. Patient profile, evacuation modalities, time elapsed since injury, and treatment modalities, including complications, were analyzed. Results: Four hundred and eighty patients were admitted over 3 years. The mean time elapsed in reaching the hospital was 7 h. Gunshot injury was the most common mechanism in 58% of the patients. 21.3% were priority I, 45.0% were priority II, whereas 33.7% were priority III. One hundred and fifty-four patients required definitive operative management. Lower extremity was the most common site. Sixty (12.5%) had penetrating abdominal trauma and 27 (5.6%) had vascular injury. Six patients succumbed to death postoperative due to various reasons. Conclusions: High-velocity firearms injury is a common cause of morbidity and mortality in military combat operations. This study highlights the challenges faced in managing high-velocity firearm injuries in such a large cohort of injured patients.

Keywords

• combat trauma care
• gunshot wound
• priority