Page 55 - Journal of Special Operations Medicine - Fall 2017

Figure 2 Percentage of bite occurrences by activity. Risk Factors for Bites
We did not identify any association between soldiers’ baseline
characteristics and the hazard of bites. Service as a combat
soldier or as a dogkeeper also did not have any effect. There
was a significant difference in time to the first bite between
these two groups, but subsequent survival analysis showed
this finding was artificial and explained by difference in mean
follow-up times. The circumstances of the bite event, however,
did matter. Almost 90% of bites occurred during training,
walking, and keeping activities, when time constraints should
not prevent a soldier from observing the safety precautions.
Nonetheless, in 91% of the events, the soldiers did not follow
the safety code. Belgian Malinois were involved in majority
of bite events, similarly to a previous report by police dog
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handlers, in which the bite ratio for Belgian Malinois was two
times higher than for German Shepherds.

Medical Burden of Bites
There is considerable medical burden associated with dog
Figure 3 Distribution of bite locations.
bites (Table 2). Every soldier bitten is routinely evacuated for
examination in the emergency department and receives a regi-
men of oral amoxicillin with clavulanic acid for 1 week. The
reported number of sick days is probably an underestimation
because some soldiers returned to the unit despite incomplete
recovery and impaired function. Some bites left such residual
complications as stiffness and reduced sensation. At the time
of questionnaire introduction, these signs had persisted for a
mean of 11 and 6 months, respectively. This implies that some
motion and sensation disturbances could still improve on sub-
sequent follow-up.

Soldiers with severe bites who had to leave active service were
not represented by the study population. The unit physician
(H.S.) recalled four such cases that occurred during 6 months
preceding this study: one case of fifth-finger near amputation,
Table 2 Bite Complications and Treatment which required re-implantation; a case of index-finger bite
Bites Occurring with extensor tendon injury treated conservatively; one case
to Combat Bites Occurring of trapezium fracture with severe bone loss and poor healing
Soldiers to Dogkeepers prognosis; and one case of index-finger bite and infection that
Characteristics (n = 115) (n = 24) p Value required hospital admission.
Deep bite, % 38 37 1
Bleeding, % 85 92 .610 Injury severity, however, was lower than that inflicted by po-
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Fracture, % 1.7 0 1 lice dogs in other reports. Hutson et al. presented a series of
Sensation 790 patients who were bitten by K-9 law enforcement dogs
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disturbance, % 23 29 .672 between 1988 and 1993. The population included individu-
Stiffness, % 15 17 1 als who were pursued and attacked by German Shepherds.
Prominent scars, % 64 67 .950 About 57% were multiple-bite events, and the complication
rates were higher: 7% were vascular injuries, 5% were infec-
IV antibiotic 28 29 1
course, % tions, 4% were open fractures and cortical violations, 1.9%
Surgical procedure, no. 11 4 .494 were nerve injuries, 1.1% were tendon injuries, and 0.9%
were open-joint injuries. Treatment included sutures in
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Total sick days per 166 59 —
group, no. 34.5% of the cases and grafting in 0.6% of the cases, whereas
IV, intravenous. 6.7% of wounds were treated in the operating room. Meade
et al. compared police records regarding law enforcement
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in Aragon, Spain. Eighty-eight percent of soldiers had experi- dog victims and emergency department visits for domestic
12
enced a dog bite. Guy et al. interviewed 3,226 veterinary clinic dog bites. They obtained information about 595 and 1,109
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clients and found that only 15.6% of domestic dog owners had patients in each group, respectively. Police victims suffered
been bitten. In a questionnaire-based study of prevalence of more severe injuries: 42% of them were admitted to the hos-
dog bites in primary school children in Trinidad, 28.1% re- pital (7%), and 73% had multiple bites (16% for domestic
ported being bitten during the preceding 3 years. The high dogs). Operations were performed in 4% of police victims
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incidence of dog bites in this MWD unit may be explained by and 2.3% of domestic victims. It appears that by injury se-
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intense work with the dogs, the high number of dogs per sol- verity, occupational bites reported by Meade et al. are closer
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dier, limited space, proximity of other dogs, and by training to domestic dog bites than to “purposeful” bites by police
methods that may increase dogs’ aggressiveness. dogs.
Bite Risk When Working With Military Dogs | 53