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The probability that a given combat wound is lethal provides a quantitative basis for the assessment of wounds, comparison of body armors, and estimation of medical workload requirements in various military scenarios. The present paper describes a new lethality model for penetrating injuries. The model employs a new injury classification called PEBL. PEBL codes are constructed by appending additional significant digits to the appropriate codes from the Hospital Adaptation of the International Classification of the World Health Organization (H-ICDA Codes), widely used in both civilian and military hospitals for injury classification. PEBL attains greater specificity by providing for injury size, bone injury characteristics, partial organ damage, and distinguishing peripheral blood vessels and nerves. Probability of lethality estimates were obtained for PEBL codes based on computerized wound data available on 3600 combat casualties.

Alexander, Yonah: Terrorism in the twenty-first century. An overview. - S. 5-10. Brown, Bertram; Prior, Stephen: The rise of the fourth horseman? - S. 11-21. Everly, George S., Jr.: Responding to mass terrorist attacks. The psychological imperative. - S. 23-30. Prior, Stephen: The probability of bioterrorism in the United States. - S. 31-35. Leitch, Robert: The medical implications of terrorism. - S. 39-47. Champion, Howard R.: Medical intelligence, modeling, and simulation. - S. 49-61. Waller, Stephen: The U.S. Air Force medical response experience. - S. 63-77. Briggs, Susan: Sustaining the response OCONUS. - S. 79-86. Ingelsby, Thomas V.: Medical and public health threats posed by biological weapons. - S. 87-94. Prior, Stephen: International terrorism and medical responses. The shape of things to come? - S. 95-104. Cecere, Fred: Communication: the vital element of medical response to terrorism. - S. 105-117. Selected documents: Interagency domestic terrorism concept of operations plan (January 2001). - S. 121-150. Public health emergency response: the CDC role (January 2001). - S. 151-155. Statement of James M. Hughes, M.D., before the Subcommittee on National Security, Veterans Affairs, and International Relations (July 23, 2001). - S. 157-165. Terrorist threats against America. Testimony to the Committee on International Relations (September 25, 2001). - S. 167-172. Executive order establishing Office of Homeland Security and the Homeland Security Council (October 8, 2001). - S. 173-181

BACKGROUND: The U.S. military conflicts in Iraq and Afghanistan had the most casualties since Vietnam with more than 53,000 wounded in action. Novel injury mechanisms, such as improvised explosive devices, and higher rates of survivability compared with previous wars led to a new pattern of combat injuries. The purpose of the present study was to use latent class analysis (LCA) to identify combat injury profiles among U.S. military personnel who survived serious wounds. METHODS: A total of 5,227 combat casualty events with an Injury Severity Score (ISS) of 9 or greater that occurred in Iraq and Afghanistan from December 2002 to July 2019 were identified from the Expeditionary Medical Encounter Database for analysis. The Barell Injury Diagnosis Matrix was used to classify injuries into binary variables by site and type of injury. LCA was employed to identify injury profiles that accounted for co-occurring injuries. Injury profiles were described and compared by demographic, operational, and injury-specific variables. RESULTS: Seven injury profiles were identified and defined as: (1) open wounds (18.8%), (2) Type 1 traumatic brain injury (TBI)/facial injuries (14.2%), (3) disseminated injuries (6.8%), (4) Type 2 TBI (15.4%), (5) lower extremity injuries (19.8%), (6) burns (7.4%), and (7) chest and/or abdominal injuries (17.7%). Profiles differed by service branch, combat location, year of injury, injury mechanism, combat posture at the time of injury, and ISS. CONCLUSION: LCA identified seven distinct and interpretable injury profiles among U.S. military personnel who survived serious combat injuries in Iraq or Afghanistan. These findings may be of interest to military medical planners as resource needs are evaluated and projected for future conflicts, and medical professionals involved in the rehabilitation of wounded service members.

Introduction Preventable injuries lead to 200 000 hospital stays, 60 000 disabilities, and 13 000 deaths per year in Canada with direct costs of $20 billion. Overall, potentially unnecessary medical interventions are estimated to consume up to 30% of healthcare resources and may expose patients to avoidable harm. However, little is known about overuse for acute injury care. We aim to identify low-value clinical practices in injury care. Methods and analysis We will perform a scoping review of peer-reviewed and non-peer-reviewed literature to identify research articles, reviews, recommendations and guidelines that identify at least one low-value clinical practice specific to injury populations. We will search Medline, EMBASE, COCHRANE central, and BIOSIS/Web of Knowledge databases, websites of government agencies, professional societies and patient advocacy organisations, thesis holdings and conference proceedings. Pairs of independent reviewers will evaluate studies for eligibility and extract data from included articles using a prepiloted and standardised electronic data abstraction form. Low-value clinical practices will be categorised using an extension of the Agency for Healthcare Research and Quality conceptual framework and data will be presented using narrative synthesis. Ethics and dissemination Ethics approval is not required as original data will not be collected. This study will be disseminated in a peer-reviewed journal, international scientific meetings, and to knowledge users through clinical and healthcare quality associations. This review will contribute new knowledge on low-value clinical practices in acute injury care. Our results will support the development indicators to measure resource overuse and inform policy makers on potential targets for deadoption in injury care.