Background and Introduction
Improvised explosive devices (IEDs), in Iraq or Afghanistan, are the primary cause of injuries to servicemen who become Polytrauma patients. These devices consist of explosives such as 155 mm artillery shells that are hidden and remotely detonated against dismounted servicemen or their convoys. In the U.S. alone, the number of servicemen currently suffering from severe Polytrauma is well over 100. This number grows substantially when considering the issue of Polytrauma in a larger context.
In prior wars, servicemen often did not survive the events capable of causing such severe multiple injuries. However, in this war, new body armor, improved combat casualty care, and more rapid evacuation procedures have caused a substantial improvement in the survival rate of wounded servicemen. For instance, the ratio of WIA to KIA in prior wars averaged 3 to 1, at present the ratio is roughly 8 to 1. Moreover, in accordance with this shift in the ratio of WIA to KIA, there has been a shift in the severity of the injuries. The Polytrauma injuries often include injuries to the hands, feet, arms, legs, face, and brain; as well as impairment of vision and hearing. Additionally, severe brain injuries from blasts, fragment penetration of the skull, and severe facial disfigurement are not uncommon. Severe facial disfigurement can sometimes lead to degraded speech function, limited and distorted facial expression, and excessive drooling.
At present, there is no treatment or rehabilitation approach that is adequately matched to these Polytrauma patients. Although there are exceptions, current approaches are generally focused on a single problem, such as limb loss or hearing loss, and are overwhelmed by the Polytrauma patient. During our conference at Dartmouth, we intend to bring together experts from multiple fields in order to consider how best to address the Polytrauma challenge.