United States Army rangers in Somalia: An analysis of combat casualties onan urban battlefield

Background: This study was undertaken to determined the differences in inju ry patterns between soldiers equipped with modern body armor in an urban en vironment compared with the soldiers of the Vietnam War. Methods: From July 1998 to March 1999, data were collected for a retrospect ive analysis on all combat casualties sustained by United States military f orces in Mogadishu, Somalia, on October 3 and 4, 1993. This was the largest and most recent urban battle involving United States ground forces since t he Vietnam War. Results:There were 125 combat casualties. Casualty distribution was similar to that of Vietnam; 11% died on the battlefield, 3% died after reaching a medical facility, 47% were evacuated, and 39% returned to duty. The inciden ce of bullet wounds in Somalia was higher than in Vietnam (55% vs. 30%), wh ereas there were fewer fragment injuries (31% vs. 48%). Blunt injury (12%) and burns (2%) caused the remaining injuries in Somalia. Fatal penetrating injuries in Somalia compared with Vietnam included wounds to the head and f ace (36% vs. 35%), neck (7% vs. 8%), thorax (14% vs. 39%), abdomen (14% vs. 7%), thoracoabdominal (7% vs. 2%), pelvis (14% vs. 2%), and extremities 17 % vs. 7%). No missiles penetrated the solid armor plate protecting the comb atants' anterior chests and upper abdomens. Most fatal penetrating injuries were caused by missiles entering through areas not protected by body armor , such as the face, neck, pelvis, and groin. Three patients with penetratin g abdominal wounds died from exsanguination, and two of these three died af ter damage-control procedures. Conclusion: The incidence of fatal head wounds was similar to that in Vietn am in spite of modern Kevlar helmets. Body armor reduced the number of fata l penetrating chest injuries. Penetrating wounds to the unprotected face, g roin, and pelvis caused significant mortality. These data may be used to de sign improved body armor.