Emergency Care Interventions for Victims of Explosive Ordnance Reduce Mortality: A Modeling Study

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Résumé

Background:Modernconflictsarecharacterizedbywide-spreaduseofconventionalexplosive
ordnance (EO), improvised explosive devices (IEDs), and other air-launched explosives. In
contrast to advances in military medicine and high-income civilian trauma systems since the
United States-led wars in Afghanistan and Iraq, the mortality rate among civilian EO
casualties has not decreased in decades. Although humanitarian mine action (HMA)
stakeholders have extensive presence and medical capabilities in EO-affected settings,
coordination between HMA and health actors has not been leveraged systematically.
Methods: Data from a prior systematic review of emergency care interventions feasible
within the context of HMA activities and low-resource health care systems were used to
model mortality reduction among EO victims. Interventions were categorized using the
World Health Organization (WHO) Emergency Care System Framework sites of “scene,”
“transport,” and “facility.” The cumulative impact of the interventions on EO-related
mortality was estimated using pooled effect estimates and simulation modeling.
Results: The meta-analysis included 16 reports from 13 countries, representing 127,505
injured persons. Pooled effect estimates across subcategories ofemergency care interventions
were 0.42 for layperson transportation (95%CI, 0.24-0.74), 0.79 for prehospital notification
systems (95%CI, 0.51-1.19), 0.52 for prehospital trauma care training courses (95%CI,
0.46-0.59), 0.67 for facility-based trauma care training courses (95%CI, 0.48-0.92), and
0.66 for facility-based trauma team organization and activation protocols (95%CI,
0.45-0.97). A 68% reduction in mortality (95%UI, 57%-79%) was observed when
implementing the full set of interventions in a region with no prior implemented
interventions.

Mots-clés

blast injury civilian casualties conflict emergency care emergency care systems explosive ordnance explosive weapons humanitarian mine action low-resource settings trauma care