Injuries associated with the use of ejection seats: a systematic review, meta-analysis and the experience of the Israeli Air Force, 1990-2019. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Epstein, Danny; Markovitz, Eden; Nakdimon, Idan; Guinzburg, Ariel; Aviram, Eliad; Gordon, Barak; Shapira, Shachar; Sharon, Saar; Steinfeld, Yaniv; Miller, Asaf; Lipsky, Ari M.
• Is Part Of: Injury. Volume 51:Issue 7(2020)
• Page Start: 1489
• Page End: 1496
• Publication Date: 2020-07
• Subjects: Ejection injuries -- Aerospace medicine -- Military medicine -- Emergency care; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.04.048
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Emergency services may be called upon to treat aircrew that has ejected and should be familiar with the injuries associated with such accidents. Among 1710 aircrew who ejected, pooled mortality and major injury rates were 10.5% and 29.8%, respectively. Survival rates have improved dramatically over the years. The major injuries included spinal fractures (61.6%), extremity trauma (27.3%), and head trauma (8.9%). The majority of spinal fractures were anterior wedge compression fractures, which in many cases were initially associated with minor symptoms. Although penetrating injuries were extremely rare, they may be seen in combat ejections. Abstract: Introduction: All modern military jet aircraft are equipped with rocket-assisted ejection systems. Jet aircraft operate in the majority of the conflict regions throughout the world, and in nearly all modern countries during peacetime. Civilian and military emergency services may be called upon to treat aircrews that have ejected and should be familiar with the common injury patterns associated with aircraft ejection. Methods: A systematic review and meta-analysis of the literature were undertaken using the preferred reporting for systematic reviews and meta-analyses (PRISMA) methodology. Peer-reviewed journal and conference papers published between 1 January 1971 and 15 June 2019 were included. Our primary outcomes of interest were mortality and major injury rates. The I 2 test was used to assess heterogeneity among the included studies, and data were pooled under random effects models. In addition, all ejection cases in the Israeli Air Force (IAF) between 1990 and 2019 were studied. The data were manually extracted from the accident records and the electronic medical records system. Results: We identified 14 studies that included 1710 aircrew ejections. Heterogeneity was high ( I 2 >75%). Pooled mean mortality and major injury rates were 10.5% (95% CI 6.8-14.8%) and 29.8% (95% CI 20.1-40.6%), respectively. The major injuries included spinal fractures (61.6%), extremity trauma (27.3%), and head trauma (8.9%). During the IAF study period, a total of 37 aircrew ejected from 26 IAF aircraft. The fatality rate was 5.4% and 18.9% suffered major injuries. Conclusions: Although ejection is lifesaving, it is associated with unique injury patterns that should be addressed during clinical evaluation. Because of their high prevalence, spinal precautions are paramount until spinal injury can be ruled out, generally by advanced imaging. Looking forward, injury patterns will continue to evolve in parallel with improving ejection seat systems.