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Area of Science:

  • Military Medicine
  • Combat Casualty Care
  • Underground Warfare

Background:

  • Underground systems have historically been utilized for military purposes.
  • Advancements in mining, combat tactics, and weaponry escalate the complexity of medical support in subterranean battlefields.
  • The Israeli Defense Force (IDF) Medical Corps has gathered extensive experience in treating casualties from underground warfare.

Purpose of the Study:

  • To describe the IDF Medical Corps' experience with treating casualties from underground warfare.
  • To analyze the challenges and outcomes of medical support in subterranean combat environments.
  • To provide recommendations based on lessons learned and literature review.

Main Methods:

  • A retrospective cohort study of casualties from underground warfare (2004-2018).
  • Data extracted from the IDF Trauma Registry and operational reports.
  • Challenges characterized by an expert committee, informed by a literature review.

Main Results:

  • 26 casualties were recorded, with blast injuries (46%), smoke inhalation (35%), and crushing injuries (19%) being prevalent.
  • Mortality was high (38% killed in action), but all 16 casualties reaching the hospital survived.
  • Key challenges were categorized as tactical, environmental, and medical.

Conclusions:

  • Effective medical support requires a deep understanding of operational planning in underground warfare.
  • The manuscript details the evolution of underground warfare, its tactical and medical implications, environmental hazards, and casualty care.
  • Focus on safety, hemorrhage control, and rapid evacuation is critical for combat casualty care in this setting.