Trauma in the Afghan guerrilla war: effects of lack of access to care.

Little or no acute medical care or evacuation capability was available to resistance forces in the Afghanistan War. We examined the effects of these constraints through a review of 1373 patients admitted to a Pakistani border hospital from 1985 to 1987. Most wounds were to the extremities (92%). Serious complications from injuries were found in 41% of cases, of which the leading causes were soft-tissue infections (36%), chronic osteomyelitis (25%), and marked restriction of joint movement (18%). For 201 patients with known cause of injury, the distribution of responsible weapons was similar to the wars in Korea, Vietnam, and the Falkland Islands. The ratio of critical-area wounds (trunk, head and neck)/extremity wounds was low (0.07) compared with most other wars (about 0.50), indicating that the most seriously injured patients died before treatment was obtained. These early deaths and the many complications from injuries reflect the lack of appropriate surgical attention and evacuation facilities in the field. It is proposed that the ratio of wounds in critical areas to wounds in the extremities might be useful in monitoring the efficiency of evacuation in similar conflicts. Early surgical management and evacuation of battle casualties could have greatly reduced mortality from the war and subsequent disabilities.