Efficient evacuation — enhanced survival: Insights from Gaza conflict trauma care

BACKGROUND: Combat-related injuries have evolved in urban warfare because of close-contact engagements and high-energy blast injuries, with rapid medical evacuation improving survival rates. This study analyzes injury patterns and outcomes in the Gaza conflict, emphasizing the need to optimize trauma care protocols in modern combat environments, particularly because of the unique proximity of conflict zones to tertiary trauma centers. METHODS: A retrospective study was conducted at a single center involving 189 patients evacuated by helicopter to a Level I tertiary trauma center. Subgroup analysis based on Injury Severity Scores was performed. RESULTS: Shrapnel impacts were the leading cause of injuries (58.7%), followed by blast injuries (48.1%) and gunshot wounds (30.7%). Extremity injuries were most common (61.4%), with 46.3% of patients needing surgery within 24 hours, mainly orthopedic procedures (75.3%). The average hospital stay was 21.9 days. In-hospital mortality rate was 4.2% (two patients). Infections occurred in 17.9% of cases, with fungal infections at 8.9% and bacterial infections at 15.3%. CONCLUSION: In modern urban warfare, effective medical interventions play a crucial role in mitigating challenges. This study emphasizes the importance of rapid evacuation and advanced trauma management, reflected in low in-hospital mortality rates, highlighting the significance of timely interventions, personal protective equipment, specialized orthopedic trauma care, and robust infection control measures. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level IV.