Israeli Army casualties in the second Palestinian uprising

This study analyzes the pattern of injuries and evacuation in this unique low-intensity conflict with many casualties and high availability of medical services and evacuation means. Injury data regarding Israel Defense Forces casualties during the first 19 weeks of the events were collected and analyzed. Ninety-six of the 356 Israel Defense Forces casualties during the first 4 months of the events were admitted or killed. Bullets (63.5%) were the most common cause of injury. Fragments and explosives accounted for 14.6% of injuries, stones and sling-thrown marbles accounted for 9.4% of injuries, and 12.5% of injuries were from miscellaneous causes. The most commonly injured body regions were the head, face, and neck (54.2%) and the limbs (50.0%). The trunk was injured in 25.0% of cases, and 4.2% of injuries were classified as external. Injury severity distribution was bimodal. The largest group represented patients with Injury Severity Scores (ISSs) between 1 and 14. The other large group was the 23 dead soldiers. The group of soldiers with ISSs between 16 and 75 included five patients only. Sixteen of the 23 dead soldiers were killed in action. Seven soldiers died of their wounds in the hospital, four of them within the first hour after admittance. A total of 83.8% of the casualties were evacuated by ambulances and the rest were evacuated by air. All casualties except one reached the hospital within 1.5 hour after the injury. Seventy-five percent of the injured were evacuated to trauma centers, and the rest were evacuated to other hospitals. The group of soldiers evacuated to trauma centers had a significantly (p = 0.021) higher mean ISS. The nature of this conflict resulted in a bimodal distribution of injuries. Most of the soldiers were either mildly injured or killed, whereas relatively few suffered severe injuries. The prehospital medical forces should be able to identify such patients and provide prompt treatment and evacuation. The abundance of head, face, neck, and limb injuries suggests that the current armor systems should be further investigated and improved.