Type, severity, location, and timing of battle casualties in a Croatian Army brigade during an offensive action in 1992

AIM

To analyze the type, severity, location, and timing of casualties in a Croatian Army brigade during an offensive action against enemy forces of about two infantry battalions timely prepared for defense.

METHODS

Casualties were analyzed according to bilateral manpower and equipment conditions, morale, time of the day, weather conditions, type of ground where the action took place, quality of planning and steering the course of the action, and especially the medical help. The action was carried out along one main and two auxiliary directions, including river crossing. The action involved about 1,000 soldiers and took 7 hours. It was divided into three phases: approaching the enemy, direct contact, and self-imposed retreat and evacuation. Medical care for the injured soldiers was organized in echelons, relying on civilian health care institutions.

RESULTS

During the action, 92 casualties were recorded. The mean injury severity according to the Abbreviated Injury Scale (AIS) was 2.9+/-1.4. The highest proportion of casualties occurred on the main direction (48 or 52.2%) but the most severe injuries were inflicted on the second auxiliary direction (mean AIS, 2.6+/-1.4). Extremely severe injuries (mean AIS, 2.0+/-1. 4) were recorded on the second auxiliary direction during the phase of retreat after a successfully performed action. However, regarding the whole action, the observed differences did not prove to be statistically significant.

CONCLUSIONS

Offensive action was properly planned and successfully led during the first two phases. Evacuation and retreat of the brigade were in part poorly organized. Health care for the soldiers functioned well throughout the action.

Injuries caused by antipersonnel mines in Croatian Army soldiers on the East Slavonia front during the 1991-1992 war in Croatia

During the war in Croatia, antipersonnel mines were mostly laid without plan by both sides, with no minefield layout, especially on the East Slavonia front. A group of Croatian disabled war veterans wounded by antipersonnel mines at the East Slavonia front from June 1, 1991, to September 1, 1992, were analyzed. The front line between the Croatian Army units and Serbian paramilitary units mostly ran along a lowland, partially swampy and wooded ground, convenient for large-scale laying of antipersonnel mines, especially so-called surprise mines. Fifty-seven soldiers suffered injuries caused by antipersonnel mines, 27 (47.4%) of them by pressure-activated mines and 30 (52.6%) by pull-action mines. The severity of wounds was assessed according to the Abbreviated Injury Scale (AIS). In the group of patients with wounds inflicted by pressure-activated mines, the mean AIS score was 4.0 +/- 0.7, with injuries to the lower extremities (mostly feet) ranging from foot-mutilating defects to partial lower-leg amputation. In the group of patients with injuries caused by pull-action mines, the mean AIS score was 3.0 +/- 0.9, indicating relatively minor injuries of different types according to the mechanism of wounding and localization. A failure to comply with minelaying regulations made protection impossible and resulted in a relatively high proportion of the wounded. The same problems are now encountered on mine removal. According to estimates, at least 10 years of intensive work of 2,000 to 3,000 trained experts will be required to clear some 2 million mines laid all over the area.

Injuries in Croatian Army brigade soldiers inflicted in an offensive action during the 1991/1992 war in Croatia

The type and number of injuries sustained by soldiers of a Croatian Army brigade in an offensive action during the war in Croatia (1991/1992) were analyzed according to the mechanism of wounding. About 1,000 soldiers participated in a 6-hour offensive action in a flat, partially swampy, and wooded area, convenient for large-scale use of antipersonnel mines and other explosive devices. There were 92 casualties in total: 15 soldiers were killed in action and 77 were lightly or severely wounded. The mechanism of wounding included shell fragments in 44 soldiers (47.8%), antipersonnel mines and gunshot projectiles in 14 soldiers each (15.3%), and others (fall, blow, stress, etc.) in 20 soldiers (21.7%). Death was recorded in 1 of 13 soldiers (7.1%) with gunshot wounds, 11 of 44 soldiers (25%) wounded by shell projectiles, and 4 of 14 soldiers (28.5%) wounded by antipersonnel mines. All injuries inflicted by shell fragments were multiple, whereas the type and severity of injury inflicted by antipersonnel mines were directly related to the type of mine. Pressure-activated mines generally caused limited injuries to the lower extremities, ranging from mutilation to amputation. Injuries inflicted by other antipersonnel mines resembled those caused by shell projectiles; however, their severity depends on a number of factors.

Transesophageal assessment of coronary flow velocity reserve during "regular" and "high"-dose dipyridamole stress testing

To assess the effect of regular and high-dose dipyridamole on coronary flow velocity in the left anterior descending artery (LAD), and to determine whether assessment of coronary flow velocity reserve (CFVR) is more sensitive for detection of ischemia than standard echocardiographic criteria, 47 patients were studied prospectively: 16 patients with stenosis of the LAD, 18 patients with angiographically normal LADs, and 13 patients with minimal disease. Patients underwent transesophageal echocardiographic study of wall motion and LAD flow velocity at baseline and at hyperemia, and for angina and electrocardiographic changes. The mean CFVR values after 0.56 mg/kg after 0.84 mg/kg of dipyridamole were similar: 2.52 +/- 0.87 versus 2.62 +/- 0.90. A CFVR <2.3 (normals mean -2 SDs) was more sensitive (88% at both doses) for the detection of underlying coronary obstruction than was wall motion monitoring (44% and 75%, respectively). The combination of CFVR <2.3 and wall monitoring was more sensitive than index alone (94% at both 0.56 and 0.84 mg/kg). The rate-pressure product was not significantly different at the two doses of dipyridamole. When flow response is the end point of stress testing, as with transesophageal monitoring, the 0.56 mg/kg dose of dipyrid mole is adequate, but when ischemia is the end point (as with wall motion monitoring by 2-dimensional echocardiography), the dose of 0.84 mg/kg is more sensitive.