Facial and neck injuries from FPV drones in Ukraine prompt the need for updated medical guidelines
The ongoing conflict in Ukraine has presented a new and terrifying dimension to warfare - the widespread use of First-Person View (FPV) drones as offensive weapons.
These new types of UAS are readily available and highly manoeuvrable devices that are being used to deliver explosive payloads with devastating accuracy, resulting in a surge of specific injuries, particularly to the face and neck. This article will explore the types of injuries caused by FPV drones, the lessons learned by emergency responders on the ground, and the critical need for rapid adaptation of medical guidelines to address this emerging threat.
The devastating impact of FPV drones
FPV drones, initially designed for recreational use, have been weaponised to carry grenades or other explosives. Their small size, speed, and ability to navigate complex environments make them incredibly dangerous. Unlike traditional artillery or missile strikes, which often cause widespread fragmentation injuries, FPV drones deliver a concentrated blast and a unique metallic or non-metallic (previously known as shrapnel) pattern. This often results in severe, localised trauma.
New types of facial and neck injuries
While comprehensive data is still emerging, reports and observations from the front lines indicate that a pattern of severe facial and neck injuries from FPV drone attacks is related primarily to penetrating trauma. The blast and fragments from FPV drone explosions can cause penetrating injuries to the face and neck, damaging vital structures like the eyes, airways, and major blood vessels. FPV drones are also related to complex fractures, as the force of the explosion can cause complex fractures of the facial bones, including the mandible (jaw), maxilla (upper jaw), and orbits (eye sockets). From an airway management perspective in the field of operations, a close detonation can lead to airway compromise. Extensive neck injuries and tissue damage from air pressure can lead to airway compromise, making breathing difficult or impossible. This is a critical concern for emergency responders. Intubation in casualties with facial injuries remains challenging even in a hospital environment (Barak et al). Damage to major blood vessels in the neck can cause massive bleeding (often non-compressible) and lead to rapid deterioration. The explosive payload can cause significant burns, further complicating wound management. Often, victims sustain a combination of these injuries, making treatment incredibly challenging. Without a forward stabilisation trauma point, the survival rate decreases significantly.
Lessons learned by emergency responders and medics
The war in Ukraine is providing a grim but valuable learning experience for emergency responders. Some key lessons include the need for specialised training, understanding the importance of rapid assessment, triage and evacuation. Understanding the limited resources and the complexity of the equipment required to sustain a potent airway in austere environments is also mandatory. Traditional trauma protocols may not be sufficient for the unique injury patterns caused by FPV drones. Specialised training is needed to manage these complex facial and neck injuries. Due to the severity of these injuries, rapid triage and evacuation to appropriate medical facilities remain crucial.
Drones are the new ”shell shock”
When it comes to the mental state component, the psychological impact on both victims and responders is significant. Support for mental health is essential. Battlefield tactics used in urban environments by state or non-state actors can also augment panic and anxiety. With the number of FPV drone users increasing, more questions arise on the moral legitimacy of drone strikes. "The persistent presence and unpredictable nature of drones in modern conflict zones create a state of constant anticipatory anxiety and fear among soldiers and civilians alike, often leading to psychological trauma akin to shell shock," as reported by the TRADOC G2 Operational Environment Enterprise.
The urgent need for updated medical guidelines
In a recent presentation by JTS, medical realities of large-scale combat operations (LSCO) have emphasised the importance of understanding the quantitative and qualitative changes to head, face, and neck injuries. In Ukraine, head, face and neck injuries rose from 20-25% to 30-35% of the total number of injuries recorded. More injury patterns show extensive soft tissue damage with bone loss, wounds often transverse to the face. External fixation to mandibular fractures is not always possible due to a lack of equipment. Lessons from Ukraine have also shown that there is a lack of skill, training or equipment required for microvascular anastomoses.
Prospects
The rapid evolution of warfare necessitates a corresponding adaptation in medical guidelines. The unique challenges posed by FPV drone-related injuries require a swift and comprehensive response from the medical community.
Research is needed to develop evidence-based protocols for the management of facial and neck trauma from FPV drones. As the development of these UAS technologies remains dynamic, healthcare systems need to prepare for the potential influx of patients with these complex injuries, ensuring adequate resources are available. Nevertheless, sharing knowledge and best practices internationally is crucial to improving outcomes, and medical professionals need access to training and education on managing these emerging injury patterns.
The war in Ukraine remains a stark reminder of the ever-changing nature of conflict. The rise of FPV drones as offensive weapons presents a new and deadly challenge. By understanding the types of injuries they cause and adapting our medical guidelines accordingly, we can better protect both victims and the emergency responders who risk their lives to save them.
Author
George Tataru
Trauma - Injury Patterns and Recognition Special Interest Group
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CTM-E is a research organisation that looks into the medical challenges posed by mass casualty incidents in Europe. It develops solutions to public policy issues to help make communities safer and more secure.
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