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Severe pediatric war trauma: A military-civilian collaboration from retrieval to repatriation
Nir Samuel1, Danny Epstein, Asaf Oren
1From the Pediatric Emergency Department (N.S., I.S.), Rambam Health Care Campus, Haifa; Department of Neurobiology (N.S.), Weizmann Institute of Science, Rehovot; Medical Corps (D.E., S.S.), Israel Defense Forces, Tel-Hashomer; Department of Internal Medicine "B" (D.E.), Rambam Health Care Campus, Haifa; Sackler School of Medicine (A.O., N.F.), Tel Aviv University, Tel Aviv; Department of Military Medicine (S.S.), Hebrew University Hadassah School of Medicine, Jerusalem; Pediatric Intensive Care Unit (Y.H.), Galilee Medical Center, Nahariya; and Pediatric Emergency Department (N.F.), Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
Insights
A coordinated military-civilian approach successfully managed severely injured pediatric warzone trauma patients, enabling their return home. This model highlights effective cross-sector collaboration for critical pediatric care.
Area of Science:
- Pediatric trauma surgery
- International medical humanitarianism
- Military medicine
Background:
- Modern conflicts disproportionately impact children, with hundreds of Syrian children seeking refuge near Israel's border.
- Severely injured children required specialized medical evacuation and treatment.
- A unique model for managing pediatric warzone trauma was established.
Purpose of the Study:
- To describe a coordinated military-civilian response for pediatric warzone trauma.
- To outline the stabilization, transport, and in-hospital management process.
- To evaluate the effectiveness of this collaborative model.
Main Methods:
- Retrospective extraction of prehospital and in-hospital data.
- Inclusion of all severe pediatric trauma cases transported via military helicopter from the Syrian border.
- Data abstracted from military and civilian trauma registries.
Main Results:
- Sixteen critically injured children (median age 9.5 years) were treated in Israeli trauma centers.
- Eight patients received in-flight interventions, including airway management and thoracostomy.
- Fifteen patients survived and returned to their families, with a median hospital stay of 34 days.
Conclusions:
- A coordinated military-civilian retrieval model can effectively manage severe pediatric warzone trauma.
- This approach facilitated life-saving interventions and recovery for critically injured children.
- The findings support the benefits of integrated medical responses in conflict zones.
Background:
Modern conflicts take a disproportionate and increasing toll on civilians and children. Since 2013, hundreds of Syrian children have fled to the Israeli border. Severely injured children were triaged for military airborne transport and brought to civilian trauma centers in Israel. After recovery, these patients returned to their homes in Syria.We sought to describe a unique model of a coordinated military-civilian response for the stabilization, transport, and in-hospital management of severe pediatric warzone trauma.
Methods:
Prehospital and in-hospital data of all severe pediatric trauma casualties transported by military helicopters from the Syrian border were extracted. Data were abstracted from the electronic medical records of military and civilian medical centers' trauma registries.
Results:
Sixteen critically injured children with a median age of 9.5 years (interquartile range [IQR], 6.5-11.5) were transported from the Syrian border to Level I and Level II trauma centers within Israel. All patients were admitted to intensive care units. Eight patients underwent lifesaving procedures during flight, 7 required airway management, and 5 required thoracostomy. The median injury severity score was 35 (IQR, 13-49). Seven laparotomies, 5 craniotomies, 3 orthopedic surgeries, and 1 skin graft surgery were performed. The median intensive care unit and hospital length of stay were 6 days (IQR, 3-16) and 34 days (IQR, 14-46), respectively. Fifteen patients survived to hospital discharge and returned to their families.
Conclusion:
The findings of this small cohort suggest the benefits of a coordinated military-civilian retrieval of severe pediatric warzone trauma.
Level Of Evidence:
Therapeutic, Level V.
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