Outcome of war-injured patients treated at first aid posts of the International Committee of the Red Cross.

This study describes the effects of 'echelons' on the outcome of victims of the Afghan internal armed conflict in terms of mortality and drain of surgical resources. A group of 1127 victims of war treated at ICRC first aid posts (FAPs) and subsequently referred to a surgical hospital of the International Committee of the Red Cross (group A), and a group of 596 victims who were transported directly from the area where the injury occurred to the hospital (group B) were analysed retrospectively. Mortality in patients treated initially at a FAP and admitted within 6-24 h after injury was slightly lower than in patients admitted directly. The number of surgical interventions was higher in patients initially treated at the FAP. Notably, patients belonging to group A with gunshot injuries underwent operation more often than those belonging to group B. No differences were found in relation to the incidence of fever, number of units of blood transfused and average stay in hospital. The study shows that initial treatment at a FAP had no significant influence on the prognosis of the injured. Presumably the best ways to improve the prognosis of the victims of war are to train local people in first aid, to support locally existing medical facilities and to establish an evacuation system in order to support these first aiders and medical facilities.