The reality of war: wounded and fallen Norwegian soldiers in Afghanistan.

BACKGROUND Norway has been contributing military forces to Afghanistan since 2001. The following is an overview of all combat-related injuries and deaths among Norwegian soldiers in the period from 2002 to 2010. MATERIAL AND METHOD All medical records for Norwegian military personnel in Afghanistan in the period to January 2011 were reviewed and those who fell or were injured during combat were identified. The mechanism and anatomical region of the injury were registered and an injury severity score (ISS), revised trauma score (RTS) and probability of survival score were calculated. Deaths were classified according to military trauma terminology and were additionally assessed as either "non-survivable" or "potentially survivable". RESULTS There were 45 injury incidents with nine deaths among 42 soldiers. The injury mechanism behind seven of the deaths was an improvised explosive device (IED). All injuries resulting in deaths were "non-survivable". Seven soldiers were severely injured. The mechanisms were bullet wounds, IED, splinters from grenades and landmine explosions. Twenty nine incidents involving 28 soldiers resulted in minor injuries. The most frequent mechanism was ricochet or splinter injury from shooting or an exploding grenade. INTERPRETATION The majority of conflict-related injuries in Afghanistan were due to explosions. The mechanism and anatomical distribution of the injuries was the same among Norwegian soldiers as among allies. The deaths were due to extensive injuries that were non-survivable.