Survivability of Wounds

[Khaki]

Has/was there ever been a study of gunshot wounds based on a % analysis of survivability?, to try and make that a little clearer, was for example an arm wound 75% more survivable than a similar leg wound or abdomen to thorax etc as a triage decision. I am not talking about massive traumatic wounds caused by shell fire

thanks

khaki

ps I am also especially interested in the mortality rate for bayonet wounds.

[Phil Evans]

Khaki,

I'm totally non-medical, but I would have thought that the major factor was not the location of the wound, but the inherent risk of infection.

Funnily enough, I have just been reading through the chapter on CCS's in a book I downloaded ages ago: Guys Hospital Reports, Volume LXX, published in 1922.

Phil

[Anneca]

Hi Khaki, like Phil I am not medically trained but have to agree that the risk of infection would be a major factor regardless of arm, leg or abdomen etc. An interesting thread non the less.

Anne

[Scalyback]

Infection.

How near a major artery?

[Khaki]

I deliberately left out the possibility of post wound infection as an unquantifiable factor, because any injury from a barbed wire scratch to a GSW was subject to bacterial infection. I am sorry to pose such an involved question, but it occurred to me that a Medical Officer in the Great War must have made decisions based on the most in need of immediate surgery and the most likely to survive. Maybe I should have left this one alone?

khaki

[johnboy]

A good question.

If a soldier recieved a GSW, was taken to nearest CCS, and after a quick once over sent to a hospital. Could be hours on a train or in an ambulance. Some could have died before reaching hospital. How many lost too much blood?

Once at the hospital how long before someone made a decision to operate?

Probably abdomen wounds were the worst to treat as a bullet might not have gone in one side and out the other...it could have gone around the body causing no end of damage.

If the hospital was recieving men from a big battle would surgeons impose a time limit on themselves to operate on individual patients? Or would they treat the lesser injured first?

Maybe a couple of the ladies with loads of info on Hospitals will be able to answer some of the questions for us.

[alougheed]

Hi there Khaki, yes there has been some attempt to analyse the casualty rates of bayonets in WWI. Mortality rate might be impossible to assess. I have my own opinion on this, but it is still evolving and I wouldn’t defend it to the death. I’ve seen some heated debates/flame wars over the historical use of bayonets and I don’t want to start another one here. Anyhow, you might enjoy reading these two blogs:

This one by Regimental Rogue, a very well researched piece:

http://regimentalrogue.com/papers/bayonet.htm

And this one by me, not so thorough, but looks at bayonet charges by the French army in August and September 1914:

http://blog.greatwarhistory.com/?p=55

Now, the traditional way of approaching the subject has been to look at stats from casualty clearing stations, but I’m not sure that is an effective way of making an assessment. I don’t think bayonets were often used to cause injury, but when they were the casualty probably died before reaching help. My reason for thinking so, based on my reading of French war diaries, is that the bayonet is mostly used in trench raids where the enemy has no opportunity to flee. Those desperate hand-to-hand struggles will either result in surrender, or they will have to fight to the death. That is my observation anyway.

[Scalyback]

Triaige?

[Khaki]

Hello alougheed,

Thank you for the interesting material, I will read it more in detail later on, I have always been suspicious of statistics on bayonet wounds as being not often treated which is probably accurate considering the wounds caused by shellfire. That however does not allow for the number of deaths that occurred quickly following a stabbing wound that may have severed everything in its journey and bled out quickly, whereas a bullet wound may close following entry and bleed very little in some cases.

khaki

[johnboy]

A bit off topic Khaki. but gives a little bit of insight.

http://www.vlib.us/medical/debrid.htm

[Khaki]

Thanks johnboy,

a good link for anyone interested in the treatment of wounds and infections in the Great War

khaki

[b3rn]

http://1914-1918.invisionzone.com/forums/index.php?showtopic=178788

Get this book!

[eairicbloodaxe]

Scalyback, triage is the word used to describe the initial assessing of patients to decide which order to treat them in.

If you're unfortunate enough to go to your local casualty dept, first person to see you will be the triage nurse. Sore finger pricked by barbed wire? Sit over there for a long wait. Bayonet injury? The doctor will see you now...

[Doc2]

Has/was there ever been a study of gunshot wounds based on a % analysis of survivability?, to try and make that a little clearer, was for example an arm wound 75% more survivable than a similar leg wound or abdomen to thorax etc as a triage decision. I am not talking about massive traumatic wounds caused by shell fire

thanks

khaki

ps I am also especially interested in the mortality rate for bayonet wounds.

There have been lots of studies on mechanisms for triage throughout the years, in many countries. All suffer from the problem that "a leg wound is not a leg wound"-- in other words, the location of a wound is not really a very good descriptor. One leg wound can be minimal, and the next can kill the patient if the femoral artery is cut. The amount of tissue damage and blood loss is much more important than location. I have seen people with bullets in the head who lived, and people with what initially appeared to be minor extremity wounds who died. Location of the wound is simply not a reliable indicator of how bad the wound is.

We have to remember that even today, most deaths on the battlefield are due to loss of blood-- and this can come from a leg wound just as well as an abdominal wound.

In modern triage systems, many things are taken into account beyond just the location of the wound. Any such system which relied only on location of wounds would be unusable, and any data which may exist based solely on this categorisation is suspect.

NATO's Allied Medical Publication (AMEDP)-38, " Medical Aspects in the Management of a Major Incident/Mass Casualty Situation" discusses triage in the following terms:

"a. Immediate Treatment Group (T1)

T1 consists of those requiring emergency care and/or life-saving surgery. One of the principles triaging patients as T1 is that they may be converted into T2 with appropriate temporary intervention(s).

b. Delayed Treatment Group (T2)

T2 consists of those in need of surgery or other medical care, but whose general condition permits delay in surgical or other special medical treatment without unduly endangering life.

c. Minimal Treatment Group (T3)

T3 consists of those with relatively minor injuries who can effectively care for themselves or who can be helped by untrained personnel.

d. Expectant Treatment Group (T4).

This group comprises patient subgroups who have received serious and often multiple injuries. One subgroup comprise hopeless cases regardless of resources and available competence, the other group those patients whose treatment would be time-consuming and complicated, with little chance of survival and consuming resources better used for less serious patients.

Note that this categorization does not include decision-making on the basis of wound location.

I suspect it would be possible to develop or even to find some table which says that, e.g. "75% of extremity wounds are not fatal, etc.", but from a clinical viewpoint, it would be pretty meaningless. It might be of interest to an administrator, but it would have little clinical utility.

[bill24chev]

I am not medically trained but have the following observations on bayonet and gunshot surviveability.

WW1 small arms ammunition was for most of the time full charge rounds of on average 7.5mm. From what I remember o fmy battlfield first aid training this type of round usualy goes in small and if it comes out it comes out with a larger wound especialy if it makes contact with bone. Hitting bone or having its velocity reduced by penetrating the tougher parts of a soldiers clothing and equipment will make it "tumble" causing much internal damage and internal bleeding if in the torso. This loss of blood and shock requires swift medical attention. If a casualty is stableised there is still a great chance of infection from dirty clothing etc.taken into the wound with the bullet and peritonitis it the bowels are damaged.

Wounds to the limbs will often cause multiple fractures and especialy on the upper leg damage to arteries and veins. Again if the casualty is stablised there is still the risk of infection.

With a bayonet wound, if only in soft tissue it will probably go in and come out with more or less the same size of wound. Hitting bone will complicate the wound and may require force to extract the bayonet causing more damage. Like gunshot wounds there is a danger of infection from debris in the wound and also from the blade it self which will probably be carrying bacteria.

For both. I believe, early medical intervention is the most important issue for survival and probably depended as much on which side controlled the ground where the casualty was lying.

Going back to the origional question about survival rates, I do not think that any accurate figures can be obtained because statistics will be skewed by the fact that many fatalities failed to reach the CCS or regimental aid post. Any figures for survival rates are based only on those casualties with bayonet or gunshot wounds who enterted the casualty evacuation system.

[centurion]

I believe that some studies were undertaken by the French and these were presented at a conference in Paris. Possibly Francophones in the forum may know more.

[alougheed]

Ya if there was a conference I'd love to see some info about that. Is that a wartime conference you are thinking of?

[centurion]

Yes I remember seeing a reference in The Lancet to it in an item on bullet wounds.

[bushfighter]

May I suggest two factors that would make statistical evidence difficult to establish in some theatres:

a. Whether casualty evacuation (CASEVAC) from the Regimental Aid Post (RAP) was possible or not, as columns in the African bush were often isolated.

b. The ethnicity of the wounded man (I have witnessed a non-European marching with bullet wounds that would have incapacitated most Europeans).

Perhaps in the France & Flanders trenches an efficient and timely CASEVAC procedure (after triage at the RAP) was established, but in other theatres the CASEVAC itself on a stretcher over long distances of rough ground and river crossings was more dangerous to the casualty than just leaving him in the RAP (and when the RAP moved on with the column the Regimental Medical Officer then had to make a tough decision about dealing with those who could not be moved).

Harry

[centurion]

Triage was certainly in use in the French army medical service in the Napoleonic period when it was basically

1. Will probably recover with no or minimal treatment - put on one side until resources are free

2. Will die whatever you do - make as comfortable as possible without diverting medical resources (Baron Larry used to suggest a very strong dose of opium if available or failing that rum or brandy)

3. Likely to recover with treatment - apply treatment.

Given that at the time any internal wound to the torso was almost certainly going to prove fatal it was fairly simple

[phil andrade]

Wound mortality statistics need to be viewed with circumspection, because, amongst other things, they reflect ability to recover wounded men and the success or otherwise in evacuating them.

It's almost counter intuitive to accept,but it transpired that the more efficient the recovery and evacuation, the higher the mortality ; the reason being that in some battles badly wounded men were brought in and accounted for before they died....in others, they were left dying on the field and only lightly wounded soldiers made it back for treatment. In the former case, the death rate was bound to be higher among the wounded who were treated, because so many severely wounded or dying men were reached and brought in. In the latter, these men tended to be posted as " missing" until they were subsequently presumed to be dead. They had endured the worst fate that can befall a soldier in battle : to be left to die by inches,beyond the aid of friend or foe.

The Australian Official Medical Historian draws attention to this in his narrative of the fighting of April and May 1917, and the differing statistics for the various phases of the Bullecourt battles that cost so much Australian blood.

In the frightful repulse of 11 April, only 32 of 1,059 of the Australian wound cases that were treated died from their wounds. But a staggering 825 were killed or left to die on the field.

In the ensuing days, the Germans counter attacked and the Australians held their ground. This time only 470 Australians were posted as killed, but 1,366 were treated for wounds, of whom 258 died. This was double the normal mortality rate for the wounded.

The wounds were chiefly by bullet writes the historian and were found " very severe", partly - and this is of some moment - because all the wounded - and therefore all serious cases - were brought in.

It would be wrong to infer from the above statistics that bullet wounds were necessarily more severe than those caused by artillery....the determining factor here was the access to and recovery of those wounded, and the accounting of their deaths whilst being treated.

Phil (PJA)

[Frank_East]

One of the medical complications from battlefield open wounds was the danger of gas gangrene setting in before adequate treatment could be effected.(Remember Derek Dooley,the Sheffield Wednesday centre forward losing a leg after breaking it at Preston in 1950 when gas gangrene set in an open wound that was caused by the break.His leg could not be saved.)

My uncle was taken POW when the 1st Monmouthshire Regiment was overrun on May 8 1915 during the Battle of Frezenberg. The family were led to believe that he sustained an ankle wound and they were marched into captivity.He must have been suffering from an infected wound for it led to a leg amputation at Wesel. and his death in October 1915.

Apparently,an essential aspect for patients recovering from wounds is the diet. POWs seldom received a good diet and for wounds to heal it is essential for enough protein to be taken in to aid recovery.

[phil andrade]

Regarding Khaki's original post, and his allusion to mortality from bayonet wounds, it is generally acknowledged that a man who was bayoneted was likely to die on the spot.

However, let's not forget that Arnold Ridley ( Private Godfrey in Dad's Army) was bayoneted in the groin in the Battle of the Somme ; Charles De Gaulle was bayoneted in the thigh at Verdun. Napoleon Buonaparte took a wound from a British pike thrust at Toulon.

Not always fatal, then.

Phil (PJA)

[Doc2]

Regarding the incidence of Bayonet wounds, and their effect..... I note in "Report on the Medico-Military Aspects Of The European War", by Surgeon A.M. Fauntleroy, USN-- 1915 the following:

"As a most valuable and inseparable adjunct to the rifle, after the

artillery has prepared the way by breaking up the barbed wire and

other obstructions, the use of the bayonet in carrying a position has

been a weighty factor during the operations of the present war. The

French bayonet, which is triangular on cross-section, needle pointed,

fluted and with one or more cutting edges, is considerably longer

(4 to 6 cm.) than any of the other bayonets. The English and continental

armies employ a knife bayonet which takes the form of

their respective hunting knives. According to trustworthy reports

from all along the front, the French and English are using their

bayonets much oftener and with more deadly effect than the Germans."

He goes on to say:

"A bayonet wound is a penetrating or cutting stab wound usually of

the abdomen, chest, or groin, and in not a few instances is multiple.

The character and result of this wound will be mentioned later in connection

with fieldwork. Sabers are used for thrusting or slashing,

and the wounds they inflict are usually multiple. The saber wound

is usually in the region of the head, right elbow, and left upper arm.

The cavalry lance is a long thrusting implement propelled with considerable

force and aimed at the trunk. The French lance has a head

of quadrangular section, 15 cm. long and 2 cm. in diameter. The

German lance has a triangular head 30 cm. long and 15 mm. in diameter.

Lance wounds are almost invariably in the trunk. As the bayonet,

saber, and lance are only used in hand-to-hand conflict, which is

a particularly ferocious kind of fighting, the fatality accompanying

these wounds can readily be understood, since it is usually a fight to

the finish between the troops engaged. Wounds from these thrusting

implements have tended to increase as the war has progressed. In

1870 there were onty 600 cases of thrust wounds out of 98,000

wounded (Delorme), while at the present time Gen. Delorme,

of the French medical service, estimates that they comprise 5 per

cent of all the wounds."

So, at least in the first 6 months or so of the war, it appears that stabbing weapons were used intensively.

[phil andrade]

Five per cent of all wounds ?

That's a bit of a stretch, surely ?

There might have been episodes which entailed unusually intense bayonet fighting. IIRC, Hastings describes one such in the ealry days of the war, in which Frenchmen were surprised at night, and large numbers bayoneted before they were properly awake.

All the same, that's such a vastly increased ratio from what we normally read about that my suspicions are aroused.

Phil (PJA)