Landmines remain a potential public health concern in the western and southern border regions of Iran. The aim of this study was to assess the health-related consequences of landmine explosions in Kurdistan Province during the past 4 decades.

This retrospective cross-sectional study was conducted in Kurdistan Province of Iran in 2016-2017. The data gathering process was questionnaire based. Survivors, or a member of the deceased’s family, were interviewed, and 410 questionnaires were completed. Data analysis was performed by using descriptive or analytical tests in SPSS software V.22.

Antipersonnel landmines caused death immediately after the explosion 32.1% of the time, and 67.9% survived with various disabilities, such as blindness, deafness, and limb amputation. Sixty-three percent of the injuries were related to limb amputation, which was the most prevalent injury among survivors. The adjusted regression test revealed a significant relationship between severity of injury and variables such as living in the villages, education, and occupation (P-value < 0.05).

Recognizing the mined areas and intensifying clearance measures are crucial for Kurdistan Province. Providing landmine awareness programs is likely to yield useful results in reducing casualties. Also, landmine survivors should have access to physical and social rehabilitation programs.

In Cambodia, a highly landmine-contaminated country with endemic malaria, symptomatic falciparum malaria has been observed in patients presenting with traumatic landmine injuries. Because a link between recrudescence of symptomatic Plasmodium falciparum malaria and severe trauma is well established, we explored whether a link could be demonstrated between the geolocation of landmine amputations and malaria cases.

Landmine amputation data in Cambodia (2005–2008) were compared with predicted measures of malaria endemicity. Data of injuries that had resulted in amputation were plotted over a surface of P falciparum parasite rates.

No statistically significant correlation was found, possibly because the P falciparum endemicity surface was drawn from a model-based geostatistical prediction of infection prevalence and did not distinguish cases of recrudescence. The implication of this finding is that where symptomatic falciparum malaria has been observed in patients with landmine injuries, the cases were likely to be reactivated falciparum infections and not new cases.

Further research is needed to understand the relationship between P falciparum and trauma. To distinguish P falciparum recrudescence from new cases, a prospective registry is needed. Also, practitioners need to be aware of the possibility of post-injury malaria recrudescence in complex emergencies. (Disaster Med Public Health Preparedness. 2014;0:1-5)

Post-injury hypothermia is a risk predictor in trauma patients whose physiology is deranged. The aim of the present study was to examine the effect of simple, in-field, hypothermia prevention to victims of penetrating trauma during long prehospital evacuations.

A total of 170 consecutively injured landmine victims were included in a prospective, clinical study in Northern Iraq and Cambodia. Thirty patients were provided with systematic prehospital hypothermia prevention, and for 140 patients, no preventive measures were provided.

The mean value for the time from injury to hospital admission was 6.6 hours (range: 0.2–72). The incidence of hypothermia (oral temperature <36°C) before prevention/rewarming was 21% (95% confidence interval: 15% to 28%). The Prevention Group had a statistically significant lower rate of hypothermia on hospital admission compared to the control group (95% confidence interval for difference: 6% to 24%).

Simple, preventive, in-field measures help to prevent hypothermia during protracted evacuation, and should be part of the trauma care protocol in rural rescue systems.

The New Injury Severity Score (NISS) was introduced in 1997 to improve outcome prediction based on anatomical severity scoring in trauma victims. Studies on populations of blunt trauma victims indicate that the NISS, predicts better than the Injury Severity Score (ISS) mortality post-injury, which is why the NISS has been recommended as the new “gold standard” for severity scoring. However, so far the accuracy of the NISS for penetrating injuries has not been validated against the ISS.

ISS and NISS scores were collected retrospectively for 1,787 war-and landmine victims in North Iraq. All victims only had penetrating injuries. The two tests were compared for prediction of short-term mortality and post-operative complications using Receiver Operating Characteristics (ROC) analysis.

Both the ISS and the NISS predicted mortality with high accuracy (ROC area under curve 0.9). There were no significant differences between the two tests. The predictive accuracy for post-operative complications was moderate for both tests (ROC-AUC <0.8), with the NISS performing significantly better than the ISS.

The NISS does not perform better than the ISS in penetrating injuries. However, this study was done on a low-risk trauma population, thus the results should not be extrapolated to high severity trauma. Due to statistical shortcomings in studies previously published, studies on far larger cohorts are necessary before the NISS should be adopted as the new “gold standard” for severity scoring.