Emergency Care Interventions for Victims of Explosive Ordnance Reduce Mortality: A Modeling Study.

Area of Science:

• Trauma care systems
• Humanitarian action
• Public health in conflict zones

Background:

• Modern conflicts involve widespread use of explosive ordnance (EO), improvised explosive devices (IEDs), and air-launched explosives.
• Civilian mortality rates from EO casualties have stagnated despite advances in trauma care.
• Coordination between humanitarian mine action (HMA) and health actors remains underutilized.

Purpose of the Study:

• To model the potential mortality reduction among civilian EO casualties.
• To assess the impact of emergency care interventions within HMA and low-resource settings.

Main Methods:

• Utilized data from a systematic review of emergency care interventions.
• Categorized interventions using the WHO Emergency Care System Framework (scene, transport, facility).
• Employed pooled effect estimates and simulation modeling to estimate cumulative impact on mortality.

Main Results:

• Analysis included 16 reports from 13 countries, covering 127,505 injured individuals.
• Key interventions showed significant potential: layperson transportation (0.42), prehospital trauma training (0.52), facility trauma training (0.67), and team protocols (0.66).
• Full implementation of interventions projected a 68% reduction in mortality (95%UI, 57%-79%).

Conclusions:

• Enhanced coordination between HMA and health actors is crucial.
• Implementing a structured set of emergency care interventions can significantly reduce preventable deaths.
• This approach offers a viable strategy for improving outcomes for civilian EO casualties.