'War surgery at sea': maritime trauma experience in the Gulf War 2003

During the second Gulf War in 2003, the Primary Casualty Receiving facility onboard R.F.A. Argus treated thirty six patients with injuries sustained in the conflict, including thirty Iraqi enemy prisoners of war and displaced persons. Their injuries and operative management are reported. Eighteen casualties sustained fragmentation injuries, six casualties sustained gunshot wounds and seven casualties suffered a combination of both. In addition to penetrating missile injuries five casualties from road traffic accidents were treated. All wounds were managed following the established principles of war surgery. The extremities were involved in twenty eight patients (78%) including nine open, multifragmented long bone fractures which were managed with external skeletal fixators. Two laparotomies and one thoracotomy were performed. The average duration of surgery was one hundred and thirty two minutes with the longest procedure lasting for six hours and ten minutes. This was the first time that the Primary Casualty Receiving Facility had been used to surgically manage war casualties and it fulfilled this role to good effect.