DTIC ADA571319: Gunshot Wounds in Military Working Dogs in Operation Enduring Freedom and Operation Iraqi Freedom: 29 cases (2003-2009)

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Retrospective Study JournalofVeterinaryEmergencyandCriticalCare23(1)2013,pp47–52
doi:10.1111/j.1476-4431.2012.00823.x
Gunshot wounds in military working dogs
in Operation Enduring Freedom and Operation
Iraqi Freedom: 29 cases (2003–2009)
JaniceL.Baker,DVM;KarynA.Havas,DVM;LauraA.Miller,LVT;Ward.A.Lacy,EMT-P,RVTand
JustinSchlanser,DVM
Abstract
Objective–Todescribethepatientpopulation,injuries,andtreatmentreceivedonthebattlefield,andultimate
outcome of U.S. military working dogs that incurred gunshot wound (GSW) injury in Operation Enduring
Freedom(Afghanistan)orOperationIraqiFreedom(Iraq).
Design–RetrospectivestudybetweenJanuary2003andDecember2009.
Animals–Twenty-ninemilitaryworkingdogsfromtheU.S.militarywithconfirmedGSWinjuriesincurredin
combatinOperationEnduringFreedomorOperationIraqiFreedom.
Interventions–None.
MeasurementsandMainResults–Clinicaldatafrombattlefieldtreatment,whichincludescarefromthepoint
ofinjurythrougharrivalto,butnotincluding,adesignatedveterinarytreatmentfacility.Twenty-ninedogswere
injuredbetween2003and2009.Allbutoneoftheinjurieswerefromhighcaliber,highvelocityweapons.Ofthe
29injureddogs,11survivedtheinjuriesand18died(38%survivalrate).Ofthedogsthatdied,allbut1died
fromcatastrophicnonsurvivableinjuriesbeforetreatmentorevacuationcouldbeinstituted.Thethoraxwasthe
mostcommonsiteofinjury(50%)followedbyextremitywounds(46%).TheleadingcauseofdeathfromGSWs
wasfromthoracicwounds,followedbyheadwounds.Dogswithextremitywoundsastheironlyinjurywere
mostlikelytosurvive,anddogswithmultipleinjurieswereleastlikelytosurvive.Allsurvivingdogsreceived
treatmentatthepointofinjurybymilitarymedicsanddoghandlersconsistentwithTacticalCombatCasualty
Careguidelinesforcombatinjuriesinhumanservicemembers.Ofthe11thatsurvived,alldogsreturnedto
fulldutywithsubsequentdeploymenttocombatzones.Locationofwoundsandinjuryseverityatthetimeof
presentationtoveterinarycarewasnotcorrelatedwithlengthoftimeuntilreturntoduty.
(JVetEmergCritCare2013;23(1):47–52)doi:10.1111/j.1476-4431.2012.00823.x
Keywords:ballisticwound,combatinjuries,penetratinginjury,trauma
ISS injuryseverityscore
Abbreviations KIA killedinaction
ATT AnimalTraumaTriage MWD MilitaryWorkingDogs
DOW diedofwounds OEF OperationEnduringFreedom
GSW gunshotwound OIF OperationIraqiFreedom
HBOC hemoglobin-basedoxygencarrier RTD Returntodutytime
TACEVAC tacticalevacuation
TCCC TacticalCombatCasualtyCare
FromJointSpecialOperationsCommand(Baker,Lacy), UnitedStatesArmy WIA woundedinaction
SpecialOperationsCommand(Miller); Ft.Bragg,NC,U.S.ArmyVeterinary
Corps, FtCollins,CO(Havas) 75thRangerRegiment, Ft.Benning,GA
(Schlanser).
Introduction
Theauthorsdeclarenoconflictofinterest.
PresentedinpartattheUSArmyCenterforHealthPromotionandPreven-
MilitaryWorkingDogs(MWDs)havebeenusedexten-
tiveMedicine(USACHPPM)ForceProtectionConference,AberdeenProving
Ground,MD,August2007. sively in current military areas of operation, including
Addresscorrespondenceandreprintrequeststo Operation Enduring Freedom (OEF) in Afghanistan
Dr.JaniceL.Baker,8221PeridotDrive#301,McLean,VA22102 and Operation Iraqi Freedom (OIF) in Iraq, and these
Email:[email protected]
SubmittedJuly12,2011;AcceptedSeptember30,2012. dogs face the same battlefield dangers as their human
NoclaimtooriginalUSgovernmentworks
(cid:2)C VeterinaryEmergencyandCriticalCareSociety2012 47
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1. REPORT DATE 3. DATES COVERED
2013 2. REPORT TYPE 00-00-2013 to 00-00-2013
4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER
Gunshot wounds in military working dogs in Operation Enduring
5b. GRANT NUMBER
Freedom and OperationIraqi Freedom: 29 cases (2003-2009)
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S) 5d. PROJECT NUMBER
5e. TASK NUMBER
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Journal of Veterinary Emergency and Critical Care 23(1) 2013, pp 47?52
14. ABSTRACT

15. SUBJECT TERMS
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J.L.Bakeretal.
counterparts. These life-threatening injuries must be “killed in action” (KIA) if they died before reaching a
treated immediately at point of injury to increase an VTF;and“diedofwounds”(DOW)iftheysurvivedto
injured dog’s chance of survival. Although veterinary arriveataVTFbutsubsequentlydiedasaresultoftheir
careisprovidedincombattheatersbyveterinariansand injuriespriortodischarge.Dogswereassignedaninjury
veterinary technicians from the U.S. Army Veterinary severityscorebasedonanAnimalTraumaTriage(ATT)
Corps, these veterinary providers are located sparsely scoringsystempreviouslydescribedbyRockaretal.,13
at bases throughout the area and medical evacuation with an ATT score of 0 indicating little or no injury,
times to veterinary care vary, and at times may exceed and the highest possible score of 18 indicating severe
24 hours. Combat medics and other human medical injury.13 Dogs that were KIA were not scored. Injuries
providers on patrol with military units have provided were recorded by body region, with a single ballistic
extensive immediate, life-saving care to injured dogs, roundpossiblycausingmorethanoneinjury.Returnto
which significantly impacted their survival from duty(RTD)timewasbasedontheU.S.ArmyVeterinary
potentiallyfatalinjury. CorpsclassificationofdeploymentcategoryforMWDs,
Optimalmanagementofgunshotwounds(GSWs)in ahierarchicalscorebasedonadog’sabilitytoperform
dogs in a civilian, peacetime setting has been well re- its duties and deploy to areas with limited veterinary
ported in the literature including retrospective stud- care.14 DogswereconsideredRTDwhenamilitaryvet-
ies,caseseries,casereports,andcomprehensivereview erinarianscoredthematthesamedeploymentcategory
articles.1–6 In addition, multiple experimental studies astheyheldbeforetheirinjury.
have described anatomical disruption and patterns of
injury, surgical repair techniques, and complication of
StatisticalAnalysis
GSWindogs.7–12Thepurposeofthisstudywastochar-
acterizetheuniqueaspectsofprehospitalcareofMWDs Comparison of medians was performed using a
injured in a combat environment, which has not been WilcoxonRankSumtestandassociationswereassessed
described before in the literature. This study provides usingtheFisher’sexacttestortheChi-squaredtest.Sta-
descriptions of injuries, battlefield treatment, and out- tisticalsignificancewasassessedatP<0.10,andPvalues
come in 29 working dogs from the U.S. Military that approaching 0.1 were discussed as well since the sam-
incurredGSWasaresultofhostileenemyactionwhile plesizewassmall.TheShapiro–WilktestforNormality
deployedtoIraqandAfghanistan. was used to assess RTD and ATT scores from the 11
observations.CorrelationwasassessedusingtheSpear-
manCorrelationCoefficientatalevelofsignificanceof
MaterialsandMethods
0.05.AKruskal–Wallisrankequalitytestwasusedtoas-
Datawerecollectedfromveterinaryrecordsofdogsin- sesstherelationshipbetweenwoundlocationandRTD.
curringGSWineitherOEFinAfghanistanorOIFinIraq, Analyseswereperformedusingcommerciallyavailable
andinmanycasesalsofrominterviewswithmilitaryper- software.a,b
sonnelinvolvedwiththeircarefrom thetimeofinjury
toreturntoduty.DatawerelimitedtoU.S.MWDsfrom
Results
2003through2009.Datafromnon-U.S.andnon-military
dogswereexcludedduetodifficultlywithfollow-up.All Twenty-nine MWDs incurred GSW injuries between
treatmentsprovidedbymedicsordoghandlerspriorto 2003 and 2009 during deployments in support of OEF
receiving veterinary care were noted, along with oper- andOIF.CasedataaresummarizedinTable1.Alldogs
ational conditions, including theater of operation (OEF exceptone(Table1,case3)wereshotwithhighpowered,
orOIF),tacticalevacuation(TACEVAC)platform(heli- high-velocityweapons.Case3wasshotwithasmallcal-
copterorgroundvehicle),evacuationtime,andwhether iberhandgun.Nodoghandlerswereinjuredalongwith
thedogs’handlerswereinjuredinthesameevent.Evac- their canine partners. Sixteen of 29 (55.2%) of the dogs
uation time was considered time from initial injury to incurring GSW were in OIF and 13 of 29 (44.8%) were
timeofarrivalatadedicatedveterinarytreatmentfacil- in OEF. The overall number of dogs deployed to these
ityinthecombattheater.Informationthatwasmissing areas that were unwounded was not available, so pro-
fromveterinaryrecordswasobtainedbyinterviewwith portional comparisons of this data were not possible.
military dog handlers and medical personnel involved However,ofthe16dogswithGSWinOIF,5of16(31%)
withthedog’scare. survived; while of the 13 dogs with GSW in OEF, 6 of
Basedonnomenclatureforhumancombatcasualties, 13(54%)survivedtheirwounds.Atotalof11/29(38%)
dogswereconsideredwoundedinaction(WIA)ifthey ofanimalswereWIAand17(59%)wereKIA.Onedog
survivedtheirwoundsandweredischargefromveteri- (0.03%)diedofhiswoundswithinanhourofarrivalto
narycare;dogsthatdidnotsurvivewerecategorizedas veterinarycareandthuswasclassifiedasDOW(Table1,
48 (cid:2)C VeterinaryEmergencyandCriticalCareSociety2012,doi:10.1111/j.1476-4431.2012.00823.x
Gunshotwoundsinmilitaryworkingdogs
Table1: MilitaryworkingdogswithGSWinjuriesbytheaterofoperations,locationofwounds,injuryseverityscore,andtimeto
returnofduty
Case Theater Wound Injuryseverity RTD
no. ofoperation location Status score (days)
1 OIF Thorax WIA 9 21
2 OIF Extremity(Rthigh) WIA 2 14
3 OEF Head WIA 9 120
4 OEF Thorax WIA 11 20
5 OIF Extremity(Rshoulder) WIA 8 125
6 OEF Extremity(RFlower) WIA 4 120
7 OIF Pelvis WIA 6 63
8 OEF Extremity(Rthigh) WIA 6 91
9 OEF Extremity(Lthigh),lumbarmusculature WIA 5 90
10 OEF Extremity(Rfront)Thorax WIA 12 120
11 OIF Thorax WIA 13 30
12 OEF Extremity(Rshoulder),thorax DOW 12 N/A
13 OIF Noinformationavailable KIA N/A N/A
14 OIF Bodynotrecovered KIA N/A N/A
15 OIF Thorax,abdomen,extremities KIA N/A N/A
16 OIF Thorax KIA N/A N/A
17 OIF Thorax,abdomen,extremities KIA N/A N/A
18 OIF BodyNotRecovered KIA N/A N/A
19 OIF Thorax,abdomen,extremities KIA N/A N/A
20 OIF Thorax KIA N/A N/A
21 OIF Head,extremities(bilateralfront) KIA N/A N/A
22 OEF Extremity(Rshoulder)thorax KIA N/A N/A
23 OIF Neck KIA N/A N/A
24 OEF Thorax KIA N/A N/A
25 OEF Thorax KIA N/A N/A
26 OEF Head KIA N/A N/A
27 OIF Neck,head,extremities,(LR,LFupper) KIA N/A N/A
28 OEF Neck,extremities(RR,RFupper) KIA N/A N/A
29 OEF Head KIA N/A N/A
OIF,Iraq;OEF,Afghanistan;KIA,killedinaction;WIA,woundedinaction;DOW,diedofwounds;RTD,returntodutytime.
case12).Thelocationsofwoundswerenotsignificantly Thebodiesof2dogswerenotrecoveredduetohaz-
associatedwiththeoutcome,butalldogsthatreceived ardousconditionsandinformationwasnotavailableon
woundstotheneckorabdomendied(Table1). 1 other dog other than a record of death by GSW in
OIF(Table1,case13,14,and18).Ofthese,10/26(39%)
hadwoundsinmultiplelocations.Dogswithextremity
Woundlocations woundsorabdominalwoundsweresignificantlymore
Ofthe29MWDswithGSW,26hadcompletedataavail- likelytohavemultiplewounds(P=0.10andP=0.03,re-
ableonwoundlocationforanalysis.Asummaryofdis- spectively).Inthedogsforwhichinformationwasavail-
tributionofwoundsinprovidedinTable1. able, the most common sites of injury were the thorax
with13/26(50%)dogsand12/26(46%)dogsreceiving
injuries in these locations respectively. In addition, all
Table 2: Wound location and RTD time in MWDs during OIF but 1 dog with extremity wounds had extremity frac-
andOEF turesassociatedwiththeGSW.
Woundlocation MedianRTD(days) IQR
RTD
Thorax 21 20,30
Extremity 105.5 52.5,122.5 OftheMWDsthatsurvived(11),allofthemRTD.Me-
Head 120 120,120 dianRTDtimeforallsurvivorswas90days,witharange
Pelvis 63 63,63 of7to120days.TherewasnocorrelationbetweenATT
Extremityandthorax 120 120,120 and RTD (correlation coefficient 0.03; P = 0.94). There
Extremityandlumbarregion 90 90,90
wasalsonoassociationfoundbetweenwoundlocation
IQR,interquartilerange. andRTD(P=0.34).
(cid:2)C VeterinaryEmergencyandCriticalCareSociety2012,doi:10.1111/j.1476-4431.2012.00823.x 49
J.L.Bakeretal.
Treatmentinthefield Discussion
Statistical analysis of the medical outcome of the
ThisisthefirststudyofcombatinjuriesinMWDsinthe
wounded MWD compared to treatment was negated
current combat conflicts. The limited number of cases
by the fact that, of the dogs that died, 17/18 (94%)
prevents thorough statistical analysis and may limit
diedwithinminutesofinjuryfromcatastrophic,nonsur-
thepowertodetectstatisticallysignificantassociations.
vivable wounds before receiving treatment. However,
However,thisreportprovidesacharacterizationofGSW
treatmentsforthosedogsthatwereWIAarefurtherde-
injuriesandoveralloutcomesthatmaybebeneficialto
scribed.
planningforemergencytreatmenttoworkingdogsthat
Noneofthedogswithextremitywoundshadmassive
sustaintraumaticinjuries.
hemorrhagerequiringapplicationofatourniquet;pres-
MoredogsincurredGSWinOIFversusOEF,19(55%)
surebandagesprovidedadequatehemostasis.Ahemo-
comparedto13(45%)respectively,butthereweremore
staticdressingcwasappliedtoasofttissueentrywound
dogsdeployedtoOIFthantoOEFduringthistimepe-
in the upper rear extremity in 1 case and was effective
riod.Inaddition,therewasahigherrateofdeathinOIF
in control of bleeding (Table 1, case 2). Gauze packing
versusOEF,9/16(69%)ad5/13(38%),respectively.The
andpressuredressingwithanelasticbandagewasused
higherrateofdeathinOIFversusOEFislikelyafactorof
effectively to control arterial bleeding in the shoulder
operationalconditionssuchasthenatureofthehostile
muscle of 1 dog with a large exit wound (Table 1, case
action,includingtypesofweaponsusedandproximity
5).Only1ofthe11survivingdogslostenoughbloodto
oftheshootertothedog.SincethemajorityoftheKIA
require blood transfusion. In that case, blood loss was
dogs died within minutes of injury from catastrophic,
from noncompressible internal hemorrhage to the tho-
nonsurvivablewounds,thisdifferenceisnotlikelydue
rax. All 4 dogs that were non-KIA dogs that incurred
tothetypeofemergencycareprovidedonthebattlefield.
thoracicwoundsdevelopedtensionpneumothoraxand
Tworecentstudiesreportedthatbetween16and23%
3ofthewoundeddogsweretreatedwithneedledecom-
ofhumancasualtiesinOIFandOEFbetween2001and
pressionofthechestinthefield,priortoreceivingcare
2005werecausedbyGSWs.15,17Sincecombatinjuriesin
byaveterinarian.The1dogwhodidnotreceiveneedle
MWDasawholearenotcurrentlybeingtracked,similar
decompression for tension pneumothorax died shortly
data are not available for canine casualties. A compre-
afterarrivingattheVTF.Anocclusivebandagewasap-
hensive retrospective study of GSW by Fullington and
pliedoverthethoracicwoundsinall4casesandheldin
Ottoin1997showedthat66of77dogs(86%)withGSW
placewithmedicaltapeandelasticbandagearoundthe
survivedtodischargefromthehospital.3Theauthorsas-
thorax.Atleast4dogsreceivedflow-byoxygen(human
sessedthatmostdogswithGSWthatreceiveadequate
oxygenmaskheldinproximitytothedog’sfaceortaped
treatment can be expected to survive. However, their
toabasket-stylemuzzle)duringevacuationtotheVTF.
studywasbasedonlyoncasesthatwerealiveatpresen-
None of the WIA dogs received IV crystalloid fluids
tation, thus this could be restated that most dogs with
priortoarrivalattheVTF.AnIVcatheterwasplacedin
GSWwhosurvivetoreceiveveterinarycarecanbeex-
1dogpriortoarrivaltoveterinarycare,andthedogwas
pectedtosurviveiftheyreceiveadequatetreatment.This
administered250mLofahemoglobin-basedoxygencar-
studyofMWDs,withamuchsmallersamplesize,mir-
rier(HBOC).dUnfortunately,thisdogsubsequentlydied
rorstheirfindings,suggestingthatdogsthatincurGSW
ofunrecognized/untreatedtensionpneumothoraxafter
incombatthatsurvivetoreceiveveterinarycarecanalso
arrival at veterinary care (Table 1, Case 3). Unsuccess-
beexpectedtosurviveifalllife-threateningwoundsare
ful attempts to place IV catheters occurred in 2 others
identified at point of injury and treated appropriately.
duringevacuation,andinoneofthese,(Table1,case5)
Moreover, the 100% RTD rate of surviving dogs in this
500mLofsubcutaneousfluidswereadministeredasan
studysuggeststhatmostdogsthatsurviveGSWincom-
alternativemethodoffluidadministration.
batcanreturntoservicefollowingtheirrecovery.
All dogs were evacuated to veterinary care by heli-
ThelackofcorrelationbetweenATTandRTDinthis
copter. Complete data were not available for all of the
groupofdogsislikelyduetothewidevarietyofwound
dogs regarding TACEVAC, but all of the evacuation
locationsinasmallsamplesize.However,althoughnot
times were estimated to be between 20–180 min from
statisticallysignificant,therewasaninterestingtrendof
thetimeofinjurytoarrivaltoveterinarycare.Onedog
dogs with the highest ATT scores having shorter RTD
receivedtreatmentin-flightwithneedledecompression
timescomparedtodogswiththelowerATTscores.This
ofthethorax(Table1,Case1).Otherin-flighttreatments
canbeexplainedbythefactthatsofttissuewoundssuch
includedflow-byoxygenadministration,administration
asthoracicwounds,whichhadthehighestATTscores,
ofsubcutaneousfluids,andmeasurestopreventortreat
takelesstimetohealthanboneasinextremityfractures,
hypothermiausingactivewarmingblanketsorreflective
which had generally lower ATT scores. RTD has not
thermalblankets.
50 (cid:2)C VeterinaryEmergencyandCriticalCareSociety2012,doi:10.1111/j.1476-4431.2012.00823.x
Gunshotwoundsinmilitaryworkingdogs
previously been assessed in canine trauma patients, so compression making direct pressure sufficient to com-
thereisnobasisforcomparisoniftheserapidRTDtimes pressdamagedbloodvessels.
aretypical. Tension pneumothorax was common among dogs
The thorax and extremities were the most common with thoracic wounds, occurring in 27% of the surviv-
sitesofinjuryfordogsinthisstudy.These2siteswere ing dogs and in 100% of dogs with GSW to the tho-
alsothemostcommonsitesfordogsthatdidnotsurvive. rax who were not KIA. Needle decompression by the
However,allofthedogsthathadextremitywoundsas medicsorhandlerspriortoreceivingveterinarycarewas
theironlyinjurysurvived,andextremitywoundswere essential in saving the lives of three dogs and empha-
not determined to be the cause of death in any of the sizes the need for training canine handlers and tactical
KIAorDOWdogs.Alsoworthnotingisthat,although medics in this emergency procedure for canine casual-
all dogs with abdominal wounds died, all dogs with ties.Althoughneedlethoracotomyforthetreatmentof
abdominal wounds also suffered other life-threatening tensionpneumothoraxisthestandardaccordingtoTac-
wounds, and the abdominal wounds themselves were ticalCombatCasualtyCare(TCCC)guidelines,20thereis
not determined to be the cause of death. In human ongoingdiscussionastoitseffectivenessinrelievingten-
service members, the most common location of GSWs sionpneumothoraxinhumancasualties,21–24mainlydue
is the extremities, and thoracic injuries are relatively tovariationsinchestwallthicknessandbodysize.This
lesscommon.15,17 Thehigherrateofthoracicinjuriesin problem is apparently not encountered among MWDs
MWDscomparedtotherateinhumanservicemembers likelyduetotherelativelyuniformbodyconformation
islikelyduetothefactthatthethoraxinhumanservice inthepopulationofMWDs.
members is usually protected by body armor. None of None of the surviving dogs received IV fluids prior
thedogsinthisstudywerewearingbodyarmor.How- toreceivingcarebyaveterinarian.Theconceptof“per-
ever,duetothepreciselocationofentrywoundsinthe missivehypotension”forpenetratingcombatinjuriesis
dogs incurring thoracic GSWs in this study, currently the standard of care with human combat casualties,20
available canine body armor, which has limited cover- and although this sample size is too small for statisti-
ageoverasmallareaofthethoraxwouldnothavebeen calsignificance,thecaninedatasuggestthatinthispa-
protectiveinmostofthesecases. tient population, IV crystalloid fluid administration in
Combatinjuriestotheextremitiesinpeoplehavethe theprehospitalphaseoftreatmentdidnotappeartobea
potentialforsignificantbloodloss,andinfact,in2anal- factorinsurvival,similartofindingsinhumancasualty
ysesofcauseofdeathinOIFandOEFinpeople,hemor- data.25
rhagefromextremitywoundswasfoundtobethesecond Official military doctrine for TACEVAC of injured
mostcommoncauseofdeath,secondtointernalhemor- MWDsconsistsofasingleparagraphinanArmyfield
rhagefromthoracicwounds.17,18InthisstudyofMWDs, manualthatstatesthatdogsmaybetransportedbyhu-
noneofthedogswithextremitywoundshadsignificant man evacuation resources.26 Despite vague guidelines,
blood loss and none were treated with tourniquets. In allofthedogsincurringGSWinthisstudywereafforded
addition,MWDswithextremitywoundswerethemost thesameevacuationresourcesastheirhumancounter-
likely to survive compared to dogs with other injury parts,andinitiationofevacuationwashandledthrough
locations. In a 1997 retrospective study of 82 dogs pre- thesamemilitarychannelsaswouldhavebeenusedfor
sentingwithGSWs,FullingtonandOttofoundthatdogs evacuation of a human casualty. Evacuation time was
with GSWs to the extremities showed the least cardio- not a significant factor in outcome, because, similar to
vascularcompromisecomparedtoinjuriesinanyother allothertreatments,allofthedogswhowereKIAdied
locationofinjury.3Inthatstudy,ofthe32dogsthathad beforetreatmentorevacuationcouldbeinitiated.
onlyextremityinjuries,29(90.3%)displayedonlymild
ornocardiovascularcompromise,andonly3(9.7%)had
Conclusion
moderatecardiovascularcompromise.Thisisnotewor-
thycomparedtohumancombatcasualtieswhereaggres- This initial data suggest that dogs that incur serious,
sivehemorrhagecontrolwithtourniquetsisoftenneces- butpotentiallysurvivableGSWinjuryincombatthatre-
saryforGSWtotheextremities.NoneoftheMWDswho ceiveimmediateandappropriatetreatmentatthepoint
incurredextremitywoundsinthisstudyrequiredtourni- of injury are likely to survive and return to full duty.
quetstocontrolbleeding.Inallcases,pressurebandages Distribution of wounds is relatively similar to human
wereadequate.Thisvastdifferenceinhemorrhagecon- combatGSWcasualties,however,basedonthislimited
trol and blood loss in canine versus human extremity dataset, severity of extremity wounds appears to vary
injuriesislikelyduetothescantmusclemassofcanine greatlyfromhumancasualtieswithsimilarinjuries.All
extremities compared to humans. This anatomical dif- ofthesurvivingdogsweretreatedonthebattlefieldus-
ferenceresultsinlesshemorrhageandlessresistanceto ingguidelinesfromhumanTCCC,priortoreceivingcare
(cid:2)C VeterinaryEmergencyandCriticalCareSociety2012,doi:10.1111/j.1476-4431.2012.00823.x 51
J.L.Bakeretal.
byaveterinarian,suggestingthathumanTCCCproce- 12.ZhangX-H,PeiG-x,WeiK-h,etal.DynamicchangesofSODand
MDAincaninelimbswithgunshotwoundinhotandhumiden-
durescanbeadaptedsuccessfullyforworkingdogsin-
vironment:anexperimentalstudyDiYiJunDaXueXueBao2002;
curringGSWincombat. 22(4):331–334.
13.RockarRA,DobratzKS,ShoferFR.Developmentofascoringsystem
fortheveterinarytraumapatient.JVetEmergCritCare1994;4(2):77–
Footnotes 83.
14.FM3–19.172005militaryworkingdogsusarmyfieldmanual.Avail-
a STATAversion12,StataCorp,CollegeStation,TX. ableat:http://www.fas.org/irp/doddir/army/fm3–19-17.pdfAc-
b Excel,MicrosoftCorp,Redmond,WA. cessed14May,2011.
c Hemcon,HemconMedicalTechnologies,Inc,Portland,OR. 15.OwensBD,KraghJFJr.,MacaitisJ,etal.Characterizationofex-
d Oxyglobin.OPKBiotechLLC.Cambridge,MA.
tremitywoundsinoperationiraqifreedomandoperationenduring
freedom.JOrthopTrauma2007;21(4):254–257.
16.OwensBD,KraghJF,WenkeJC,etal.Combatwoundsinopera-
References tioniraqifreedomandoperationenduringfreedom.JTrauma2008;
64(2):295–299.
1.BarrySL,LafuenteMP,MartinezSA.Arthropathycausedbyalead 17.Belmont PJ, Schoenfeld AJ, Goodman G. Epidemiology of com-
bulletinadog.JAmVetMedAssoc2008;232(6):886–888. batwoundsinOperationIraqiFreedomandoperationenduring
2.DohertyMA,SmithMM.Contaminationandinfectionoffractures freedom:orthopaedicburdenofdisease.JSurgOrthopAdv2010;
fromgunshottraumaindogs:20cases(1987–1992).JAmVetMed 19(1):2–7.
Assoc1995;206(2):203–205. 18.HolcombJB,McMullinNR,PearseL,etal.Causesofdeathofus
3.FullingtonRJ,OttoCM.Characteristicsandmanagementofgunshot specialoperationsforcesintheglobalwaronterrorism2001–2004.
woundsindogsandcats:84cases(1986–1995).JAmVetMedAssoc AnnSurg2007;245(6):986–991.
1997;210(5):658–662. 19.KellyJF,RitenourAE,McLaughlinDF,etal.Injuryseverityand
4.PavleticMM.Gunshotwoundmanagement.CompendContinEduc causesofdeathfromOperationIraqiFreedomandOperationEn-
PractVet1996;18(12):1285–1299. duringFreedom:2003–2004versus2006.JTrauma2008;64:S21–S27.
5.PavleticMM.Gunshotwoundsinveterinarymedicine:projectile 20.Tacticalcombatcasualtycareguidelines2009.Availableat:http://
ballistics-PartI.CompendContinEducPractVet1986;8(1):47–60. usaisr.amedd.army.mil/tccc/TCCC%20Guidelines%20091104.pdf.
6.BebchukTN,HarariJ.Gunshotwoundinjuries:pathophysiology Accessed14May,2011.
andtreatments.VetClinNoAmSmallAnimPract1995;25(5):1111– 21.FitzgeraldM,MackenzieCF,MarascoS,etal.Pleuraldecompres-
1125. sionanddrainageduringtraumareceptionandresuscitation.Injury
7.LiuJ,PengX,LiuY,etal.Microsurgicalrepairatearlystateforsoft 2008;39(1):9–20.
tissuedefectoflimbswoundedbymodernfirearm.ClinJTraumatol 22.ZengerinkI,BrinkPR,LauplandKB,etal.Needlethoracostomyin
20025(3):142–145. thetreatmentofatensionpneumothoraxintraumapatients:what
8.ZhangJ,WangW,ChenW,etal.Emergentcardiopulmonaryby- sizeneedle?JTrauma2008;64(1):111–114.
passincanineswithpenetratingcardiacwoundscausebygunshot. 23.RathinamS,BeetmanA,SteynRS.Needlethoracostomyintreat-
EmergMedJ200724(11):764–768. mentoftensionpneumothoraxintraumapatients.JTrauma2008;
9.YuL,XuR-x,PengP,etal.Establishmentofcaninemodelsofpen- 65(4):964.
etratingcraniocerebralgunshotwound.DiYiJunDaXueXueBao 24.EcksteinM,SuyaharaD.Needlethoracostomyintheprehospital
2004;24(12):1404–1406. setting.PrehospEmergCare1998;2(2):132–135.
10.WeiK-h,PeiG-x,LuoB-d,etal.Bacteriumcultureandfloraanalysis 25.DuttonRP,MackenzieCF,ScaleaTM.Hypotensiveresuscitation
ofgunshotwoundonlimbsofdogsinhotandhumidenvironment. duringactivehemorrhage:impactonin-hospitalmortality.JTrauma
DiYiJunDaXueXueBao2002;22(1):20–21. 2002;52(6):1141–1146.
11.YangZ-h,ZhuP-f,JiangJ-j,etal.Pathomorphologicalchangesin 26.DepartmentoftheArmy.EvacuationofmilitaryworkingdogsSec-
abdominal viscerae in dogs subjected to underwater blast wave tion4.13.FM8–10-6MedicalEvacuationinaTheaterofOperations
injuries.ChinCritCareMed2004;16(4):226–228. Washington,DC14January2006.
52 (cid:2)C VeterinaryEmergencyandCriticalCareSociety2012,doi:10.1111/j.1476-4431.2012.00823.x