{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:33:27Z","timestamp":1787621607481,"version":"build-2736575974"},"reference-count":15,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,21]]},"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe pattern 1 injuries caused by the antipersonnel improvised explosive device (AP-IED) in comparison to those previously described for antipersonnel mines (APM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study of 100 consecutive pedestrian victims of an AP-IED, with traumatic amputation without regard for gender, nationality or military status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Multinational Medical Unit at Kandahar Air Field, Afghanistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>One hundred consecutive patients, all male, 6\u201344 years old.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The details of injuries were recorded to describe the pattern and characterise the injuries suffered by the target of AP-IEDs. The level of amputation, the level of soft tissue injury, the fracture pattern (including pelvic fractures) as well as perineal, gluteal, genital and other injuries were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Victims of AP-IED were more likely, compared with APM victims, to have multiple amputations (70.0% vs 10.4%; p&lt;0.001) or genital injury (26% vs 13%; p=0.007). Multiple amputations occurred in 70 patients: 5 quadruple amputations, 27 triple amputations and 38 double amputations. Pelvic fracture occurred in 21 victims, all but one of whom had multiple amputations. Severe perineal, gluteal or genital injuries were present in 46 patients. Severe soft tissue injury was universal, with injection of contaminated soil along tissue planes well above entry sites. There were 13 facial injuries, 9 skull fractures and 3 traumatic brain injuries. Eleven eye injuries were seen; none of the victims with eye injuries were wearing eye protection. The casualty fatality rate was at least 19%. The presence of more than one amputation was associated with a higher rate of pelvic fracture (28.6% vs 3.3%; p=0.005) and perineal\u2013gluteal injury (32.6% vs 11.1%; p=0.009).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The injury pattern suffered by the target of the AP-IED is markedly worse than that of conventional APM. Pelvic binders and tourniquets should be applied at the point of injury to patients with multiple amputations or perineal injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2016-014697","type":"journal-article","created":{"date-parts":[[2017,8,23]],"date-time":"2017-08-23T21:11:49Z","timestamp":1503522709000},"page":"e014697","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":33,"title":["Injury profile suffered by targets of antipersonnel improvised explosive devices: prospective cohort study"],"prefix":"10.1136","volume":"7","author":[{"given":"Shane","family":"Smith","sequence":"first","affiliation":[{"name":"Royal Canadian Medical Service, London, Ontario, Canada"},{"name":"Division of General Surgery, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Devine","sequence":"additional","affiliation":[{"name":"Royal Canadian Medical Service, Halifax, Nova Scotia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Taddeo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Maine Veterans' Affairs Medical Center, Augusta, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2479-6862","authenticated-orcid":false,"given":"Vivian Charles","family":"McAlister","sequence":"additional","affiliation":[{"name":"Royal Canadian Medical Service, London, Ontario, Canada"},{"name":"Division of General Surgery, University of Western Ontario, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,7]]},"reference":[{"key":"2025121222434800000_7.7.e014697.1","first-page":"211","article-title":"Convention on the Prohibition of the use, stockpiling, production and transfer of anti-personnel mines and on their destruction","volume":"2056","author":"Nations","year":"1999","journal-title":"United Nations, Treaty Series"},{"key":"2025121222434800000_7.7.e014697.2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.303.6816.1509"},{"key":"2025121222434800000_7.7.e014697.3","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(96)00066-6"},{"key":"2025121222434800000_7.7.e014697.4","first-page":"405","article-title":"Amputation for antipersonnel mine injuries of the leg: preservation of the tibial stump using a medial gastrocnemius myoplasty","volume":"71","author":"Coupland","year":"1989","journal-title":"Ann R Coll Surg Engl"},{"key":"2025121222434800000_7.7.e014697.5","first-page":"595","article-title":"Amputations due to landmine and unexploded ordinances in post-war Iran","volume":"11","author":"Soroush","year":"2008","journal-title":"Arch Iran Med"},{"key":"2025121222434800000_7.7.e014697.6","doi-asserted-by":"crossref","first-page":"1037","DOI":"10.1016\/j.injury.2011.12.017","article-title":"Changes in surgical workload at the JF Med Gp Role 3 Hospital, Camp Bastion, Afghanistan, November 2008-November 2010","volume":"43","author":"Jacobs","year":"2012","journal-title":"Injury"},{"key":"2025121222434800000_7.7.e014697.7","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1016\/j.injury.2012.01.005","article-title":"Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices","volume":"43","author":"Beckett","year":"2012","journal-title":"Injury"},{"key":"2025121222434800000_7.7.e014697.8","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.injury.2014.01.025","article-title":"Acute bilateral leg amputation following combat injury in UK servicemen","volume":"45","author":"Penn-Barwell","year":"2014","journal-title":"Injury"},{"issue":"Suppl 3","key":"2025121222434800000_7.7.e014697.9","doi-asserted-by":"crossref","first-page":"S104","DOI":"10.1503\/cjs.013114","article-title":"Cervical spine injury in dismounted improvised explosive device trauma","volume":"58","author":"Taddeo","year":"2015","journal-title":"Can J Surg"},{"key":"2025121222434800000_7.7.e014697.10","doi-asserted-by":"crossref","first-page":"S124","DOI":"10.1503\/cjs.024811","article-title":"The Role 3 Multinational Medical Unit at Kandahar Airfield 2005-2010","volume":"54","author":"Brisebois","year":"2011","journal-title":"Can J Surg"},{"key":"2025121222434800000_7.7.e014697.11","unstructured":"Bryusov PG , Shapovalov VM , Artemyev AA , et al . Combat injuries of extremities. Moscow: Military Medical Academy, GEOTAR, 1996. 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War Surgery: working with limited resources in armed conflict and other situations of violence (Volume 2). 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