Type, Severity of Iraq War Injuries Change...(e published in the June 16 issue of the ...),Health

For the study, Brethauer's team looked at records from a combat trauma database for 338 casualties treated during the first phase of the war, as well as 895 casualties during the insurgency phase. Compared with the initial phase of the war, there were more major injuries per Marine during the insurgency (2.4 compared to 1.6). There were also more fragment wounds during the insurgency, (61 percent versus 48 percent). But, there were fewer gunshot wounds during the insurgency (33 percent compared to 43 percent), the report found.

Since the start of the insurgency, it has taken longer for injured Marines to reach surgical units than it did during the initial phase of the war. Patients wounded during the insurgency reached surgical units, on average, 59 minutes after injury, compared with 30 minutes during the initial phase of the war, Brethauer said.

Also, the number of Marines killed in action before reaching a surgical unit has risen to 20.2 percent since the insurgency, from 13.5 percent during the initial phase of the war. And Marines who died from their wounds also increased during the insurgency, from 0.88 percent to 5.5 percent, Brethauer said.

Mortality rates during the insurgency have risen to rates seen in other wars, such as Vietnam, Brethauer said. "The invasion had an exceptionally low rate of people being killed in action and dying of wounds," he said. "When we got into the insurgency, we saw what we had seen in prior major conflicts, which is around a 20 percent killed-in-action rate and a 5 percent died-of-wounds rate."

To cut down on deaths, Brethauer recommended moving the surgical units closer to the battle site and bypassing battalion aid stations for the most critically injured patients.

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