Page 104 - Journal of Special Operations Medicine - Winter 2014

defined but related to anyone in a harness who is sta- • Head injury can be fatal or severely impair the ability
tionary and vertical. Swift action must be undertaken to escape the postcrash environment and the associ-
in these cases. Injuries can occur quickly (~10 minutes) ated hazards.
and include: • Statistically significant injury patterns:
o Facial bone fractures are associated with lacera-
• third spacing in the lower extremities, resulting in hy- tions of the brain and rib fractures.
potension and shock; o Rib fractures are associated with lacerations of the
• possible reperfusion injury (treat per CRUSH proto- lungs and heart, and injury to the liver, aorta, and
col); and spleen.
• loss of consciousness and death.

Water landings can involve entanglement in equipment, References
and inhaling or ingesting water. 1. Malish RG. The medical preparation of a Special Forces
Company for pilot recovery. Mil Med. 1999;164:881–884.
Finally, burns can result from descent into or near an 2. Naval Aerospace Medical Institute. U.S. Naval Flight Sur-
aircraft fireball or wreckage. geon’s manual, 3rd ed. Washington, DC: The Bureau of
Medicine and Surgery, Department of the Navy; 1991.
3. Werner U. Ejection associated injuries within the German
Helicopter Accident Injuries Air Force from 1981–1997. Aviat Space Environ Med. 1999;
70:1230–1234.
A study by Taneja and Wiegmann includes a review of 4. Pattarini JM, Blue RS, et al. Flat spin and negative Gz in
9
84 autopsies of pilots killed in fatal helicopter accidents. high-altitude free fall: pathophysiology, prevention, and
Percentages noted next to each type of injury indicate treatment. Aviat Space Environ Med. 2013;84:961–970.
the incidence of that injury found in this population. 5. Knapik JJ, Steelman R, Grier T, et al. Military parachut-
ing injuries, associated events, and injury risk factors. Aviat
The primary cause of death was blunt trauma (88%). Space Environ Med. 2011;82:797–804.
Other causes were thermal (burns) (4%–5%), drown- 6. Deaton TG, Roby JL. Injury profile for airborne operations
ing, exsanguination, inhalation of smoke and toxic utilizing the SF-10A maneuverable parachute. J Spec Oper
gases, hypothermia, and asphyxia. Med. 2010;10:22–25.
7. Craig SC, Lee T. Attention to detail: injuries at altitude
among U.S. Army Military static line parachutists. Mil.
Breakdown of traumatic injury by body region is as Med. 2000;165:268–271.
follows: 8. Wilson DJ, Parada SA, Slevin JM, Arrington ED. Intra-
substance ruptures of the biceps brachii: diagnosis and
• Head: skull fractures (51%), facial bone fractures management. Orthopedics. 2011;34:890–896.
(47%), and brain injuries (67%) 9. Taneja N, Wiegmann DA. Analysis of injuries among pi-
• Thorax: lung injury (60%), heart (41%), aorta (38%), lots killed in fatal helicopter accidents. Aviat Space Environ
and sternum fracture (25%) Med. 2003;74:337–341.
• Abdomen (the incidence of abdominal injuries is
lower than other body regions): spleen (32%), liver Disclosures
(47%), and pelvic fracture (30%)
• Fractures: The authors have nothing to disclose.
o upper extremity: clavicle (21%), humerus (25%),
and radius/ulna (16%)
o lower extremity: femur (27%), tibia (34%), fibula
(31%) Lt Col McBratney is a board-certified orthopedic surgeon,
o pelvis (30%) with a subspecialty certification in orthopedic sports medicine,
o spine: thoracic (30%), cervical (25%), and lumbar. stationed at Davis-Monthan AFB, Arizona.
• Thermal injuries: antemortem (before death) (3%); Lt Col Rush is the USAF pararescue medical director and
postmortem (after death) (21%) a pararescue flight surgeon in the NY Air National Guard.
E-mail: stephencrush@me.com.
Contact injuries and blunt trauma are a greater con-
cern than deceleration forces. Use of head protection Col Kharod is a board-certified emergency physician, for-
and shoulder restraint can significantly influence injury mer wing surgeon of the 24th Special Operations Wing, and
patterns. currently, the senior fellow in the Military EMS and Disaster
Medicine Fellowship, JBSA-Ft Sam Houston, Texas.
• 50% of fatalities in survivable US Army helicopter ac-
cidents were caused by head strikes.

94 Journal of Special Operations Medicine Volume 14, Edition 4/Winter 2014