AFGHAN-WAR WOUNDED - APPLICATION OF THE RED-CROSS WOUND CLASSIFICATION

Objective: This study was designed to illustrate the application of th e Red Cross classification system as a guide to treatment and to demon strate its ease of use, especially in situations where the treating su rgeons may have little experience with or knowledge of ballistic detai ls. Design: The wounds of 123 victims of fighting in Afghanistan are d escribed and categorized according to the Red Cross classification sys tem. Materials and Methods: Recent factional fighting in Afghanistan r esulted in 123 casualties being admitted to an International Committee of the Red Cross (ICRC) hospital in Quetta, Pakistan, close to the Af ghan border. These casualties suffered more than 1300 wounds in total; the two most severe mounds in each casualty were categorized accordin g to the Red Cross classification, described here. This wound classifi cation is quick and easy to apply; it focuses the surgeon's attention on the wound, without requiring any familiarity with terminal ballisti cs. Measurements and Main Results: The majority of wounds, caused by a ntipersonnel fragments (68.3% of casualties), affected only the soft t issues. Bullet wounds were fewer (22.8% of casualties), but tended to be more severe, often involving a fracture, vascular damage, or injury to a vital structure. Conclusions: The Red Cross classification permi ts identification of wound patterns and provides a data base for revie w of clinical practice and outcome. It is hoped that further data gath ered in this manner from ICRC hospitals and others receiving war wound ed will add to the understanding of the clinical practice and problems in war surgery.