Background: Uncontrolled hemorrhage is a leading cause of preventable death in trauma. Tourniquets (TQs) are commonly used to control bleeding in the prehospital setting, although their application is associated with risks. Therefore, this study aimed to identify complications arising from TQ use and to examine contributing risk factors.Methods: This retrospective observational study reviewed the medical records of adult trauma casualties (>18 years) hospitalized at Chaim Sheba Medical Center (SMC) between 2010 and 2020 who had a TQ applied in the prehospital setting. The primary outcome was the rate and type of complications. Logistic regression analyses identified risk factors using demographic, injury, and clinical data.Results: From 2010 to 2020, a total of 84 trauma casualties with documented prehospital TQ application were hospitalized at SMC. Of these, 20 (23.81%) experienced TQ‐related complications, including local infection, compartment syndrome, and thromboembolism. The average TQ application time was 44.2 min, with no significant difference between those with and without complications. However, significant differences were noted in the mechanism of injury (MOI), wound contamination levels, indications for TQ application, and initial blood test results (p < 0.05). Logistic regression analyses revealed length of stay (LOS) and injuries from falls were significantly associated with the development of complications.Conclusions: This study found that a significant trauma in prehospital settings requiring TQ application is associated with a high rate of complications. Early complications, including local infections and compartment syndrome, were more frequent, whereas late complications like thromboembolism and muscle atrophy were less common. The findings suggest that factors such as the MOI and wound contamination may contribute to these complications, yet after applying multivariate regression, LOS and falls were the only variables found to be significantly associated with the development of complications. These findings underscore the need for further research comparing casualties with and without TQ application.

Neck injuries in warfare are critical due to the concentration of vital structures within a relatively unprotected anatomical region. This study aims to provide a comprehensive analysis of the epidemiology, severity, and outcomes of neck injuries during Military operations under “Operation Swords of War,” leveraging data from the Israeli National Trauma Registry. Data were retrospectively collected for casualties from October 7, 2023, through December 31, 2023. Injury characteristics, time to surgical exploration, and in-hospital outcomes were analyzed. A total of 1815 trauma casualties were recorded, with 147 (8.1%) suffering from neck injuries. The majority of these injuries were due to penetrating trauma (89.8%), with a significant number leading to surgical exploration (45.0%). The study highlighted the extensive use of resources for managing these severe injuries, including operating rooms and intensive care units. The findings underscore the high prevalence and severity of neck injuries in military conflicts and the critical need for rapid assessment and intervention. Comparisons with previous conflicts suggest an improvement in survival rates due to enhanced medical response and triage efficiency. In conclusion, neck injuries remain a significant concern in combat settings, necessitating specialized trauma care and rapid intervention strategies. The results from this study provide vital insights that can help improve trauma care protocols and outcomes in future conflicts.

Background: Maxillofacial injuries (MFI) in warfare present significant challenges due to the concentration of vital structures in the facial region and the high‐energy mechanisms of injury. This study analyzes the epidemiology, severity, and outcomes of MFI during the Swords of Iron conflict using data from the Israeli National Trauma Registry. Methods: A retrospective analysis was conducted on casualties from October 7, 2023 to August 1, 2024. Injury characteristics, surgical interventions, intensive care unit (ICU) admissions, and mortality rates were assessed. Logistic regression identified predictors for severe head injury and surgical intervention. Results: Of 1654 casualties, 324 (19.6%) sustained MFI, predominantly from explosions (85.2%). Fractures were associated with higher ICU admission rates (60.6% vs. 20.0%, p < 0.0001) and greater surgical intervention requirements (65.4% vs. 36.4%, p = 0.0001) than soft tissue injuries. Orbital fractures (59.6%) were the most common and strongly correlated with severe head injury (OR 9.33, CI 4.29–21.54, p < 0.001). Zygomatic (OR 8.47), maxillary (OR 5.81), and mandibular fractures (OR 12.61) significantly predicted the need for surgery, whereas orbital fractures often did not. Airway management was required in 26.5% of MFI cases, significantly higher than in other injuries (12.6%, p < 0.001). The overall mortality rate was low, with 7.7% in the fracture group and 0.9% in the soft tissue injury group. Conclusion: MFI in combat settings demands specialized trauma care, particularly for fractures requiring surgical intervention and intensive care. The high prevalence of orbital fractures and their association with severe head injuries highlight the need for early recognition and intervention despite their being less prone to surgical correction. These findings can inform trauma care protocols to optimize management and outcomes in future conflicts.

Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements. A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05. Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3). Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.