Analysis of Burn Casualties in the Swords of Iron War

The Swords of Iron (SOI) War is an armed conflict between Israel and Hamas, which has been taking place in Gaza from October 2023 until the present time of writing this article. This war is characterized by urban close-contact combat. The combat equipment, weaponry, and protective measures employed differ markedly from those in previously documented major conflicts, significantly impacting the types of injuries sustained by soldiers. This study examines the number of injured soldiers in combat, field mortality rates, incidence of burns and trauma, demographic details of the injured, causes and distribution of injuries, burn characteristics, hemodynamic status, and injury severity. This is a retrospective, registry-based cohort study. Military personnel treated by Israel Defense Forces (IDF) medical teams with burn injuries from the ground maneuver in Gaza between October 27, 2023, and April 2024 were included in the analysis. Diagnosis of burn injuries was made in the prehospital setting and recorded in the patient's casualty cards and the IDF trauma registry and/or in the hospitals, and then recorded by the Israel National Trauma Registry. A total of 2627 documented military personnel were included. Of them, there were a total of 249 burn casualties. They were all male combat soldiers, and their mean age was 22 years. Most of the burn injuries were combined with other injuries; only 12% were defined as in a shock state, and 14% received whole blood in the field. The burn degree was second- and third-degrees for most cases. A third (34%) of burn-injured soldiers had surgery (Table 2), and half of the total were sent to rehabilitation departments following their initial hospitalization. An analysis of total body surface area (TBSA)% affected by burns among SOI War casualties reveals a higher proportion of severe burns exceeding 20% TBSA, compared to previous conflicts. Additionally, a higher proportion of personnel suffered from second and third degree burns. This is likely attributed to the operational mode of the IDF in Gaza, where urban close-contact warfare exposes soldiers to heightened risks of explosive and blast injuries. A significant percentage of live casualties had TBSA percentages that were not life-threatening, which underscores the importance of updating emergency burn treatment protocols and employing rapid evacuation and medical response systems in the field. Most of the wounded that suffered from significant burns had other significant and life-threatening injuries, making the appropriate protective measures and the preparation for rapid evacuation the best way to improve burn casualty survival. The significance of this research lies in the timely analysis of accumulated combat data to derive lessons and conclusions relevant to ongoing and future conflicts and to understand the clinical implications arising from combat situations. Given the relatively high prevalence of burn injuries, understanding their etiology, severity, and consequences is essential for developing effective prevention and treatment courses.