A conference in Tampa looks for better ways to treat soldiers who are hurt in battlefield explosions.
By LISA GREENE
Published December 11, 2004
TAMPA - First comes the shock wave, which can bring immediate death.
Then it's the shrapnel tearing into skin, the crush of falling walls, the body landing hard after being hurled into the air.
All are part of why the injuries soldiers face from explosives are different, and often worse, than bullets.
Doctors and others who tend to such injuries will discuss them at a conference Sunday at the Hyatt Regency Tampa, designed to help health care workers learn more. The conference is sponsored by James A. Haley VA Hospital, the Defense and Veterans Brain Injury Center and the University of South Florida.
"A lot of these explosion injuries have multiple problems," said Dr. Steven Scott, Haley's chief of rehabilitation medicine. "Not just amputees, but other problems. How are we going to take somebody and return them to work or teach them to walk on an artificial leg when they can't think clearly?"
Health care workers need to learn more about how to treat the possible complications of such injuries, and how to work in teams to treat multiple injuries, Scott said.
Haley has set up a blast injury program to treat returning soldiers, and doctors say they hope the hospital will be named as one of four national centers for such injuries under a law signed last month by President Bush.
Injuries from explosives have long been a part of war. During the American Revolution, doctors wrote about the soldiers with no visible injuries being found dead on the battlefield - hit by the blast waves from cannon fire.
"They called them the winds of war," Scott said.
In major 20th century wars, blast injuries accounted for about 30 percent of the wounded.
But in Iraq and Afghanistan, doctors say, 60 percent to 80 percent of the injuries have come from blasts.
Part of the reason is more land mines and suicide bombers.
But soldiers also are more likely to survive such blasts. Their body armor is better and battlefront medical care has improved, with surgeons getting to soldiers much faster.
In World War II, about 30 percent of injured soldiers died, according to an article published this week in the New England Journal of Medicine. In Vietnam, that dropped to 24 percent. In Iraq and Afghanistan, the figure has dropped to 10 percent.
But those injuries can be devastating.
First, there is the high-pressure blast wave.
"These blasts can go up to 700, 1,300 mph. That pressure hits them," Scott said.
Besides the danger of being hit by shrapnel or other debris, contaminated soil or other objects can pose a risk of infection.
Soldiers may have burns and may be at risk of bleeding to death, even from small wounds because there are so many of them, wrote Dr. Atul Gawande in the journal article.
Blasts mangle soldiers' limbs so badly that it is more difficult to decide whether and how to amputate. Traditional criteria for amputation decisions often don't seem to work, Gawande said, and some soldiers have faced blood loss and infections when surgeons have tried to save wounded limbs.
Head injuries from explosions are especially complex, said neurologist Dr. Warren Lux, deputy director of the Defense and Veterans Brain Injury Center, a speaker at Sunday's conference.
Some soldiers get brain injuries from shrapnel tearing through their skulls. Others have closed-head injuries, which may have no visible wound. Often, the brain has been damaged by by slamming against the skull when the soldier hits his head.
Some injuries don't seem to fit traditional categories, Lux said. Some soldiers returning from Iraq and Afghanistan did not have open wounds and did not black out. But they still have difficulty with basic thinking functions - problems such as recognizing shapes or faces, adding, subtracting, recognizing words.
Doctors are studying whether these soldiers' brains were hurt by the shock wave or the blast itself.
"Why are they different?" Lux said. "It's clear the blast has a direct impact on the lungs and the GI tract. Whether the skull protects the brain or not remains to be determined."
IF YOU GO
A conference about blast injuries is scheduled for 1 to 5:30 p.m. Sunday at the Hyatt Regency Tampa. It is free and open to the public. Doctors expect a wide range of health care workers, such as doctors, EMS personnel, social workers and physical therapists, to attend.
