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Traumatisé de guerre: Cela évolue

Systematic review of the prevalence and characteristics of battle casualties from NATO coalition forces in Iraq and Afghanistan

Hoencamp R. et All. Injury, Int. J. Care Injured 45 (2014) 1028–1034

Background: The North Atlantic Treaty Organization (NATO) coalition forces remain heavily committed on combat operations overseas. Understanding the prevalence and characteristics of battlefield injury of coalition partners is vital to combat casualty care performance improvement. The aim of this systematic review was to evaluate the prevalence and characteristics of battle casualties from NATO coalition partners in Iraq and Afghanistan. The primary outcome was mechanism of injury and the secondary outcome anatomical distribution of wounds.
Methods: This systematic review was performed based on all cohort studies concerning prevalence and characteristics of battlefield injury of coalition forces from Iraq and Afghanistan up to December 20th 2013. Studies were rated on the level of evidence provided according to criteria by the Centre for Evidence Based Medicine in Oxford. The methodological quality of observational comparative studies was assessed by the modified Newcastle-Ottawa Scale.
Results: Eight published articles, encompassing a total of n = 19,750 battle casualties, were systematically analyzed to achieve a summated outcome. There was heterogeneity among the included studies and there were major differences in inclusion and exclusion criteria regarding the target population among the included trials, introducing bias. The overall distribution in mechanism of injury was 18% gunshot wounds, 72% explosions and other 10%. The overall anatomical distribution of wounds was head and neck 31%, truncal 27%, extremity 39% and other 3%.

Battlefield .jpg

Conclusions: The mechanism of injury and anatomical distribution of wounds observed in the published
articles by NATO coalition partners regarding Iraq and Afghanistan differ from previous campaigns. There was a significant increase in the use of explosive mechanisms and a significant increase in the head and neck region compared with previous wars.


Mousses auxétiques: Encore mieux protégés !

Literature Review: Materials with Negative Poisson's Ratios and Potential Applications to Aerospace and Defence

Liu Q. DSTO Defence Science and Technology Organisation

De nombreuse recherches portent sur l'amélioration des effets de protection. Le recours à de nouvelles fibres, le mode de tissage, l'emploi de plaques de céramique permettent actuellement de disposer d' équipements efficaces. Le recours aux nanoparticules est actuellement une voie de recherche, mais ce n'est pas la seule. De nouveaux matériaux ayant la propriété d'augmenter de volume quand ils sont étirés ou soumis à une pression sont utilisables. Ces matériaux sont des mousses dites auxétiques.





The army hearing program

Heritage of army audiology and the road ahead: The Army Hearing Program

Mc Ilwain DS et all. Am J Public Health. 2008;98:2167–2172

Il n'y a pas que le PTSD qui soit considéré comme un enjeu majeur de dépistage et de traitement. La perte auditive bénéficie également d'un programme de grande ampleur au sein de l'armée américaine.

Les deux images qui suivent expliquent pourquoi:

1. La fréquence des déficits auditifs liés au combat


Un point détaillé récent ici

2. L'ouie est un système d'arme:


 Ce document vous en décrit  les grandes lignes


"   Noise-induced hearing loss has been documented as early as the 16th century, when a French surgeon, Ambroise Pare´ , wrote of the treatment of injuries sustained by firearms and described acoustic trauma in great detail. Even so, the protection of hearing would not be addressed for three more centuries, when the jet engine was invented and resulted in a long overdue whirlwind of policy developmentaddressingtheprevention of hearing loss. We present a synopsis of hearing loss prevention in the US Army and describe the current Army Hearing Program, which aims to prevent noise-induced hearing loss in soldiers and to ensure their maximum combat effectiveness.............

   With hearing conservation programs documenting marked initial improvements, the anticipated cost of veterans’ disability claims and payments were expected to decrease over time.10,11 However, with the start of the war in Afghanistan in 2001 and the war in Iraq in 2003, this proved not to be the case. Current data show that 51.8% of combat soldiers have moderately severe hearing loss or worse, mainly because of the loud sounds associated with combat. The implications for the army are great. When soldiers reach these levels of hearing loss, they must be evaluated for the ability to perform their duties safely and effectively. Depending on the findings, they may be given the option of changing to a job that does not put their hearing at further risk or leaving the service with a medical discharge......


| Tags : blast


Blast et audition: Le responsable ?

Mechanisms of Hearing Loss after Blast Injury to the Ear 

Cho S. et All. Plos One 8(7): e67618. doi:10.1371/journal.pone.0067618

Given the frequent use of improvised explosive devices (IEDs) around the world, the study of traumatic blast injuries is of increasing interest. The ear is the most common organ affected by blast injury because it is the body’s most sensitive pressure transducer. We fabricated a blast chamber to re-create blast profiles similar to that of IEDs and used it to develop a reproducible mouse model to study blast-induced hearing loss. The tympanic membrane was perforated in all mice after blast exposure and found to heal spontaneously. Micro-computed tomography demonstrated no evidence for middle ear or otic capsule injuries; however, the healed tympanic membrane was thickened. Auditory brainstem response and distortion product otoacoustic emission threshold shifts were found to be correlated with blast intensity. As well, these threshold shifts were larger than those found in control mice that underwent surgical perforation of their tympanic membranes, indicating cochlear trauma. Histological studies one week and three months after the blast demonstrated no disruption or damage to the intra-cochlear membranes. However, there was loss of outer hair cells (OHCs) within the basal turn of the cochlea and decreased spiral ganglion neurons (SGNs) and afferent nerve synapses. Using our mouse model that recapitulates human IED exposure, our results identify that the mechanisms underlying blast-induced hearing loss does not include gross membranous rupture as is commonly believed. Instead, there is both OHC and SGN loss that produce auditory dysfunction. 


Expérimentalement, La perte auditive n'est pas liée à l'atteinte du tympan mais plutôt à l'atteinte des cellules ciliées externes et du ganglion spiral de corti. L'image qui suit tirée d'un autre document vous présente les grandes causes d'atteinte de l'audition. 


| Tags : blast


Dehors et dedans, ce n'est pas la même chose

Primary blast lung injury prevalence and fatal injuries from explosions: Insights from postmortem computed tomographic analysis of 121 improvised explosive device fatalities

SIngleton JAG et all. J Trauma Acute Care Surg. 2013;75: S269-S274.



Primary blast lung injury (PBLI) is an acknowledged cause of death in explosive blast casualties. In contrast to vehicle occupants following an in-vehicle explosion, the injury profile, including PBLI incidence, for mounted personnel following an external explosion has yet to be as well defined.


This retrospective study identified 146 cases of UK military personnel killed by improvised explosive devices (IEDs) between November 2007 and July 2010. With the permission of Her Majesty's Coroners, relevant postmortem computed tomography imaging was analyzed. PBLI was diagnosed by postmortem computed tomography. Injury, demographic, and relevant incident data were collected via the UK Joint Theatre Trauma Registry.


Autopsy results were not available for 1 of 146 cases. Of the remaining 145 IED fatalities, 24 had catastrophic injuries (disruptions), making further study impossible, leaving 121 cases; 79 were dismounted (DM), and 42 were mounted (M). PBLI was noted in 58 cases, 33 (79%) of 42 M fatalities and 25 (32%) of 79 DM fatalities (p < 0.0001). Rates of associated thoracic trauma were also significantly greater in the M group (p < 0.006 for all). Fatal head (53% vs. 23%) and thoracic trauma (23% vs. 8%) were both more common in the M group, while fatal lower extremity trauma (7% vs. 48%) was more commonly seen in DM casualties (p < 0.0001 for all).



Following IED strikes, mounted fatalities are primarily caused by head and chest injuries. Lower extremity trauma is the leading cause of death in dismounted fatalities. Mounted fatalities have a high incidence of PBLI, suggesting significant exposure to primary blast. This has not been reported previously. Further work is required to determine the incidence and clinical significance of this severe lung injury in explosive blast survivors. In addition, specific characteristics of the vehicles should be considered.

| Tags : blast, balistique


Contamination des plaies: A l'entrée et la sortie

Effect of Initial Projectile Speed on Contamination Distribution in a Lower Extremity Surrogate “Wound Track”

Krebsbach MA et All., Military Medicine, 177, 5:573, 2012 


Le nettoyage précoce et la couverture des orifices d'entrée et de sortie sont donc théoriquement des maillons importants de la lutte contre l'infection des plaies de guerre.

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Blast des membres

Blast-related fracture patterns: a forensic biomechanical approach

Ramasamy A. et All. J. R. Soc. Interface (2011) 8, 689–698

Dehors et dedans, ce n'est pas la même chose


Les lésions dépendent du type de blast


| Tags : blast


Blast TBI: Un seuil plus bas que pour le poumon

Working toward exposure thresholds for blast-induced traumatic brain injury: thoracic and acceleration mechanisms.

Courtney MW et all. Neuroimage, 2011 Jan,54 Suppl 1: S55-61

Les mécanismes du blast cérébral associent la tansmission de la surpression via le thorax, l'impact direct sur la boite crânienne et les phénomènes d'accélaration de l'extrémité céphalique. Ce document explore la première voie et exprime bien que les seuils lésionnels de lésions cérébrales  (courbes de Ono) sont plus bas que les seuils pulmonaires(courbes de Bowden).



| Tags : balistique, tbi


Mesurer l'exposition au blast: Une réalité

 La nécessité de connaître le niveau d'exposition à une onde de blast commence à devenir évidente.Des dispositifs adaptés  appraissent sur le marché. Parmi ceux ci le BLAST GAUGE semble intéressant. Porté sur le casque, le gilet pare-balle ou tout autre surface il enregistre l'onde de pression, permet la reconnaissance du niveau par led colorée et l'analyse de la courbe par récupération des données sur un ordinateur.

Le dispositif


 Port sur le casque


D'autres systèmes sont proposés comme le système HEADS de la société BAE dont près de 20 000 dispositfs ont été fournis à l'amée américaine  et il est hautement propable que ce type de ce produit va très rapidement être mis en oeuvre dès lors qu'une expsoition à de fortes explosions notamment en milieu clos est attendue.

| Tags : blast, balistique


Immobilisation du rachis: Dès que possible ! Surtout si VBIED


J Trauma Acute Care Surg. 2013;74: 1112-1118

Si l'atteinte du rachis cervical était dans les derniers conflits est de l'ordre de 1 à 2%, ce taux est monté à 5-8% dans le conflit irakien. Ceci s'explique par l'émergence d'un nouveau mécanisme d'aggression par IED. La procédure du sauvetage au combat stipule que l'imobilisation du rachis cervical ne doit pas être réalisée sous le feu direct de l'ennemi. La frequence des lésions du rachis dans les combats actuels l'impose cependant dès que blessé et sauveteurs sont à l'abri surtout si il s'agit d'un VBIED. C'est que suggère cette publication édifiante qui porte sur l'analyse des lésions du rachis cervical chez les soldats décédés. 


| Tags : rachis, balistique


Ballistic trauma. A practical guide


Pour accéder au document

| Tags : balistique


Balistique: Actualisation OEF/OIF

Combat wounds in Iraq and Afghanistan from 2005 to 2009

J Belmont JP et all. (J Trauma Acute Care Surg. 2012;73: 3-12)

Morceaux choisis: 

Among the 1,992,232 military service members who were deployed, there were 29,624 distinct combat wounds in 7,877 combat casualties. The mean age of the combat casualty cohort was 26.0 years old. The combat casualties were predominantly male (98I8%), Army (77,5%), and junior enlisted (59,0%). The distribution of combat wounds was as follows: head/neck, 28,1%; thorax, 9,9%; abdomen, 10,1%; and extremities, 51,9%. Explosive injury mechanisms accounted for 74,4% of all combat casualties, which was significantly higher than those caused by gunshot wounds (19,9%) (p G 0.0001). From 2005 to 2007, explosive mechanisms of injury were significantly more common in Iraq than in Afghanistan (p G 0.001). The percentage of explosive mechanisms increased significantly in Afghanistan between the years 2007 (59,5%) and 2008 (73,6%) ( p < 0.0003)

In addition, 1,064 (13,5%) of all combat casualties also sustained burn injuries

MOI .jpeg



| Tags : balistique


VBIED: Le point UK

In-vehicle extremity injuries from improvised explosive devices: current and future foci

Ramasamy A et all. Phil. Trans. R. Soc. B 2011  366, 160-170

The conflicts in Iraq and Afghanistan have been epitomized by the insurgents’ use of the improvised explosive device against vehicle-borne security forces. These weapons, capable of causing multiple severely injured casualties in a single incident, pose the most prevalent single threat to Coalition troops operating in the region. Improvements in personal protection and medical care have resulted in increasing numbers of casualties surviving with complex lower limb injuries, often leading to long-term disability. Thus, there exists an urgent requirement to investigate and mitigate against the mechanism of extremity injury caused by these devices. This will necessitate an ontological approach, linking molecular, cellular and tissue interaction to physiological dysfunction. This can only be achieved via a collaborative approach between clinicians, natural scientists and engineers, combining physical and numerical modelling tools with clinical data from the battlefield. In this article, we compile existing knowledge on the effects of explosions on skeletal injury, review and critique relevant experimental and computational research related to lower limb injury and damage and propose research foci required to drive the development of future mitigation technologies.



| Tags : balistique


Les plaies du cou: Danger

Mortality and morbidity from combat neck injury

Breeze J. et all. J Trauma. 2012;72: 969–974.



Neck injury represents 11% of battle injuries in UK forces in comparison with 2% to 5% in US forces. The aim of this study was to determine the causes of death and long-term morbidity from combat neck injury in an attempt to recommend new methods of protecting the neck.


Hospital and postmortem records for all UK servicemen sustaining battle injuries to the neck between January 1, 2006 and December 31, 2010 were analyzed.


Neck wounds were found in 152 of 1,528 (10%) of battle injured service personnel. Seventy-nine percent of neck wounds were caused by explosions and were associated with a mortality rate of 41% compared with 78% from gunshot wounds (GSWs). Although current UK OSPREY neck collars can potentially protect zone I from explosive fragments, in the 58% in which the wearing of a neck collar was known, all service personnel chose not to wear the collar. The most common cause of death from explosive fragments was vascular injury (85%). Zone II was the most commonly affected area overall by explosive fragments and had the highest mortality but zone I was associated with the highest morbidity in survivors.


Nape protectors, that cover zone III of the neck posteriorly, would only have potentially prevented 3% of injuries and therefore this study does not support their use. Current UK OSPREY neck collars potentially protect against the majority of explosive fragments to zones I and II and had these collars been worn potentially 16 deaths may have been prevented. Reasons for their lack of uptake by UK servicemen is therefore being evaluated. Surface wound mapping of penetrating explosive fragments in our series has been used to validate the area of coverage required for future designs of neck protection. 


1. Des lésions essentiellement antérieures


2. Une atteinte surtout des zones 1 et 2

3. 28% des décédés sont porteurs de lésions cervicales en rapport direct avec le décès dans 73% des cas.

4. Des causes de décès différentes en fonction du type lésionnel


5. Un manque d' adhésion au port de la protection qui expliquerait cette fréquence, une histoire d'ergonomie ?


Du même auteur: Lire aussi


Exposition répétées: Plus graves ! ou ?

Primary blast survival and injury risk assessment for repeated blast exposures

Panzer MB et all. J Trauma. 2012;72: 454–466.

Les conflits afghnas et irakiens ont vu les personnels des armées occidentales confrontées à de nouvelles modalités d'exposition à des ondes de surpression. Leur caractèes répété est responsable de lésions plus graves. Cet article actualise un certain nombre de données.

Ces quelques diagrammes expriment de manière très claire la relation entre le pic de pressions, sa durée et la répétition sur la survie et les lésions observées.



The widespread use of explosives by modern insurgents and terrorists has increased the potential frequency of blast exposure in soldiers and civilians. This growing threat highlights the importance of understanding and evaluating blast injury risk and the increase of injury risk from exposure to repeated blast effects.


Data from more than 3,250 large animal experiments were collected from studies focusing on the effects of blast exposure. The current study uses 2,349 experiments from the data collection for analysis of the primary blast injury and survival risk for both long- and short-duration blasts, including the effects from repeated exposures. A piecewise linear logistic regression was performed on the data to develop survival and injury risk assessment curves.


New injury risk assessment curves uniting long- and short-duration blasts were developed for incident and reflected pressure measures and were used to evaluate the risk of injury based on blast overpressure, positive-phase duration, and the number of repeated exposures. The risk assessments were derived for three levels of injury severity: nonauditory, pulmonary, and fatality. The analysis showed a marked initial decrease in injury tolerance with each subsequent blast exposure. This effect decreases with increasing number of blast exposures.


The new injury risk functions showed good agreement with the existing experimental data and provided a simplified model for primary blast injury risk. This model can be used to predict blast injury or fatality risk for single exposure and repeated exposure cases and has application in modern combat scenarios or in setting occupational health limits.





| Tags : blast, explosion


Audition du combattant et blast

Ear injuries sustained by British service personnel subjected to blast trauma

Breeze J. et all. The Journal of Laryngology & Otology (2011), 125, 1317


To describe the pattern of ear injuries sustained by all British servicemen serving in Iraq and Afghanistan between 2006 and 2009; to identify all servicemen evacuated to the Royal Centre for Defence Medicine following blast injury; to ascertain how many underwent otological assessment; and to calculate the incidence of hearing loss.

Design and setting:

A retrospective analysis of data obtained from the Joint Theatre Trauma Registry and the Defence Analytical and Statistics Agency, together with audiometry records from the University Hospitals Birmingham National Health Service Trust.


Ear damage was present in 5 per cent of all British servicemen sustaining battle injuries. Tympanicmembrane rupture occurred in 8 per cent of personnel evacuated with blast injuries. In 2006, 1 per cent of servicemen sustaining blast injury underwent audiography; this figure rose to 13 per cent in 2009. Fifty-three per cent of these audiograms were abnormal.

Ear 1.JPG




The incidence of tympanic membrane rupture was higher than that found in previous conflicts. Otological assessment prior to and following military deployment is required  to determine the incidence of ear injury amongst British servicemen following blast trauma.

| Tags : blast, explosion


Balistique terminale: Historique


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| Tags : balistique