Journal of Trauma and Injury

Review Article

Heat-related illnesses in the Republic of Korea Armed Forces: epidemiology, comparative analysis, and preventive strategies: Sunju Kim, Kun Hwang; Received September 1, 2025 Accepted January 2, 2026 Published online September 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0212 [Epub ahead of print]

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Abstract PDF: Heat-related illnesses (HRIs) represent an increasingly critical threat to the health and operational readiness of the Republic of Korea (ROK) Armed Forces. Rising global temperatures, combined with Korea’s humid summers and intensive military training, have increased both the incidence and severity of HRIs among soldiers. This paper provides a comprehensive review of HRIs in the ROK military, beginning with an overview of their pathophysiology and classification, ranging from heat cramps to exertional heat stroke—the most severe and life-threatening form. We then examine recent epidemiological trends, which reveal over 1,200 documented cases between 2018 and 2023, with new recruits disproportionately affected. A comparative analysis across service branches indicates that Army personnel, who engage in high-intensity outdoor training, bear the greatest burden, while Navy and Air Force members face distinct occupational exposures in engine rooms and on airfields, respectively. The risk in the ROK military is striking in international comparison: odds ratios suggest that soldiers face more than 27 times the risk of HRIs compared with the civilian population, exceeding reported burdens in allied militaries such as the United States and Japan. Lessons from other nations, particularly the use of real-time surveillance, wearable technologies, and structured acclimatization programs, offer valuable models for ROK. Preventive strategies must therefore extend beyond medical management to include leadership accountability, environmental engineering, digital monitoring, and a cultural shift that promotes reporting. In an era of accelerating climate change, HRIs must be reframed not only as medical conditions but also as preventable threats to combat readiness, soldier welfare, and national security.; Summary

Original Articles

Changes in the characteristics of civilian patients admitted to a military hospital before and during the healthcare system crisis: a retrospective cohort study: Changsin Lee, Sang Mok Lee, Kyungwon Lee; J Trauma Inj. 2026;39(1):14-24. Published online March 3, 2026; DOI: https://doi.org/10.20408/jti.2025.0096

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Abstract PDF: Purpose
In February 2024, a healthcare system crisis in Korea, triggered by the mass resignation of medical residents in protest of government medical policies, resulted in an increased influx of civilian trauma patients to a military trauma center. This study examines the scale, characteristics, and treatment outcomes of these patients before and during the crisis.
Methods
A retrospective review was conducted, comparing civilian trauma patients who visited the center from March 2023 to February 2024 (before crisis) and from March 2024 to February 2025 (during the crisis). The variables analyzed included patient demographics, injury types, methods of transportation, length of emergency room (ER) stay, hospitalization outcomes, and final treatment results. Only civilian trauma patients who required hospitalization were included; mild cases discharged from the ER were excluded.
Results
A total of 548 civilian patients visited the center during the study period, with a significant increase observed during the crisis (364 patients during the crisis vs. 81 patients before the crisis). Despite the surge, there were no significant differences in hospital arrival routes, methods of transportation, mechanisms of injury, or injury types. ER stay durations were shorter for both general and severe cases during the crisis (P=0.020 and P=0.033, respectively), although intensive care unit and overall hospital stay lengths remained unchanged. Civilian outpatient visits increased more than threefold in March 2024 compared to February 2024, and this elevated trend remained stable.
Conclusions
These findings highlight the military trauma center’s ability to maintain effective civilian trauma care despite significant healthcare system disruptions. The study underscores the resilience of the center and offers insights for optimizing trauma care operations in future crises.; Summary

Vulnerability of the border area: analysis of the Traffic Accident Analysis System in Korea: Doo-Hun Kim, Hangjoo Cho, Sung Yub Jeong, Maru Kim; J Trauma Inj. 2025;38(2):91-96. Published online June 19, 2025; DOI: https://doi.org/10.20408/jti.2024.0100

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Abstract PDF: Purpose
This study assessed patient vulnerability following traffic accidents (TAs) in Korea’s border area (BA).
Methods
The BA includes cities and counties directly adjacent to the demilitarized zone with North Korea. The rear area (RA) is defined as the area immediately adjacent to the BA. TA data from 2017 to 2021 were obtained from the Traffic Accident Analysis System in Korea. Information on road length, population, number of TAs, injured patients, and fatalities was collected. The number of TAs and fatalities per 1 km of road length and per 100,000 people was calculated. Severity (number of fatalities per 100 TA cases) and lethality (number of fatalities divided by the sum of fatalities and injured patients) were used to assess the vulnerability of each area.
Results
A total of 55,463 TAs were analyzed. Although the RA exhibited higher numbers of TAs and deceased patients per 1 km of road length and per 100,000 people, the BA showed significantly higher fatalities per 100,000 people as well as increased severity and lethality.
Conclusions
The BA is more likely to be associated with death following TAs, despite a lower overall TA incidence compared to the RA. Further analysis is needed to address and mitigate this vulnerability.; Summary

Lessons from foreign military surgeons in the Korean War: advancing trauma surgery and preparing for future conflicts: Kun Hwang, Chan Yong Park; J Trauma Inj. 2025;38(2):103-110. Published online June 16, 2025; DOI: https://doi.org/10.20408/jti.2025.0041

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Abstract PDF

Purpose
The Korean War (1950–1953) significantly advanced military medicine, with foreign military surgeons playing a pivotal role in transforming trauma care under extreme conditions.
Methods
Resources such as PubMed, JSTOR, and reports from participating nations formed the basis of this study. A thorough comparative analysis was performed to examine the similarities and differences in medical practices between the United Nations Command and North Korean forces.
Results
The United States introduced Mobile Army Surgical Hospitals, revolutionizing trauma care by enabling rapid intervention near combat zones. Innovations such as helicopter evacuation, whole blood transfusions, and antibiotic treatments reduced mortality rates among treated soldiers to as low as 3%. British surgeons excelled in managing abdominal wounds and performing orthopedic surgery, often undertaking limb-saving procedures. Field hospitals provided comprehensive care for combat injuries and infectious diseases—a major concern given the inadequate sanitation. The Indian 60th Parachute Field Ambulance treated over 20,000 casualties, demonstrating adaptability in harsh environments. The Indian Field Hospital not only treated military casualties but also provided care to Korean civilians, offering life-saving medical interventions under challenging conditions. Denmark deployed the hospital ship MS Jutlandia, equipped with advanced surgical facilities, enabling a level of medical care that was not practical on land. The Swedish Red Cross Field Hospital in Busan delivered crucial medical aid to both military personnel and civilians; its staff focused on civilian outreach and controlling epidemics, with treatments targeting diseases such as typhoid and tuberculosis. Norwegian mobile surgical teams specialized in rapid interventions near combat zones, performing life-saving operations within hours of injury and thus minimizing complications and increasing survival rates.
Conclusions
The lessons learned from these contributions continue to influence modern military and civilian healthcare systems, highlighting the importance of innovation, collaboration, and resilience in conflict settings.

Summary

Citations

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Classification of gunshot wounds of the thyroid gland
E.M. Khoroshun, I.A. Lurin, K.V. Misiura, V.V. Makarov, V.V. Nehoduiko, Yu.V. Bunin, B.M. Chernobil, N.Yu. Seliukova
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 21(7): 681. CrossRef

Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients: Jeong Il Joo, Changsin Lee, Kyungwon Lee; J Trauma Inj. 2024;37(4):262-267. Published online December 4, 2024; DOI: https://doi.org/10.20408/jti.2024.0037

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Abstract PDF

Purpose
Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts.
Methods
We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization.
Results
The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry.
Conclusions
This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.

Summary

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Penetrating chest injury caused by a rubber bullet in a Republic of Korea Army soldier: a case report
Chansin Lee, Kyungwon Lee
Journal of Acute Care Surgery.2025; 15(3): 164. CrossRef

Traumatic peripheral nerve injuries in young Korean soldiers: a recent 10-year retrospective study: Chul Jung, Jae-hyun Yun, Eun Jin Kim, Jaechan Park, Jiwoon Yeom, Kyoung-Eun Kim; J Trauma Inj. 2024;37(3):192-200. Published online August 8, 2024; DOI: https://doi.org/10.20408/jti.2024.0001

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Abstract PDF

Purpose
Traumatic peripheral nerve injury (PNI), which occurs in up to 3% of trauma patients, is a devastating condition that often leads to permanent disability. However, knowledge of traumatic PNI is limited. We describe epidemiology and clinical characteristics of traumatic PNI in Korea and identify the predictors of traumatic complete PNI. Methods: A list of enlisted soldier patients who were discharged from military service due to PNI over a 10-year period (2012–2021) was obtained, and their medical records were reviewed. Patients were classified according to the causative events (traumatic vs. nontraumatic) and injury severity (complete vs. incomplete). Of traumatic PNIs, we compared the clinical variables between the incomplete and complete PNI groups and identified predictors of complete PNI. Results: Of the 119 young male patients who were discharged from military service due to PNI, 85 (71.4%) were injured by a traumatic event; among them, 22 (25.9%) were assessed as having a complete injury. The most common PNI mechanism (n=49, 57.6%), was adjacent fractures or dislocations. Several injury-related characteristics were significantly associated with complete PNI: laceration or gunshot wound, PNI involving the median nerve, PNI involving multiple individual nerves (multiple PNI), and concomitant muscular or vascular injuries. After adjusting for other possible predictors, multiple PNI was identified as a significant predictor of a complete PNI (odds ratio, 3.583; P=0.017). Conclusions: In this study, we analyzed the characteristics of enlisted Korean soldiers discharged due to traumatic PNI and found that the most common injury mechanism was adjacent fracture or dislocation (57.6%). Patients with multiple PNI had a significantly increased risk of complete injury. The results of this study contribute to a better understanding of traumatic PNI, which directly leads to a decline in functioning in patients with trauma.

Summary

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Lymphatic vessel regulates tertiary lymphoid structure formation and inflammatory intensity in peripheral nerve allografts
Beibei Xu, Hui Zhou, Yuan Liu, Nianci Huo, Junyang Gao, Jiaqi Liu, Nan Zhou
International Immunopharmacology.2026; 188: 117287. CrossRef
Nerve injury: the role of electroneuromyography and ultrasound in diagnostics
A. V. Klimkin, M. A. Irikova, V. B. Voitenkov, E. Yu. Skripchenko
Russian neurological journal.2025; 30(1): 51. CrossRef
Analysis of Penetrating Injuries to the Sciatic Nerve, Highlighting Insights From Sudan
Albra Kamal, Momen M. Mohamed, Amin M. Yassin, Hozifa Mohamed, Mohamed Dirar
Plastic and Reconstructive Surgery - Global Open.2025; 13(6): e6901. CrossRef

One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series: Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee; J Trauma Inj. 2023;36(4):376-384. Published online December 19, 2023; DOI: https://doi.org/10.20408/jti.2023.0041

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Abstract PDF

Purpose
The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity.
Methods
In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients’ mode of transport.
Results
This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, grenade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder.
Conclusions
This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.

Summary

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The PTSD-Bone Axis: Evidence, Mechanisms, and Management
Olivia X. Jones, Kirsten D. Kelly, Stephanie K. Khoo, Ryan R. Kelly, Sara J. Sidles, Amanda C. LaRue
Current Osteoporosis Reports.2026;[Epub] CrossRef
Changes in the characteristics of civilian patients admitted to a military hospital before and during the healthcare system crisis: a retrospective cohort study
Changsin Lee, Sang Mok Lee, Kyungwon Lee
Journal of Trauma and Injury.2026; 39(1): 14. CrossRef
Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients
Jeong Il Joo, Changsin Lee, Kyungwon Lee
Journal of Trauma and Injury.2024; 37(4): 262. CrossRef

Case Report

Inhalation injury after a landmine explosion: a case report: Woojung Kim, Donghoon Kim, Sung Yub Jeong, Yoonhyun Lee, Hojun Lee; J Trauma Inj. 2022;35(Suppl 1):S35-S39. Published online June 23, 2022; DOI: https://doi.org/10.20408/jti.2022.0005

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Abstract PDF

Blast injuries are divided into four classes, and inhalation injuries are a quaternary class of blast injuries. An inhalation injury can be critical to the patient due to the possibility of related complications, such as airway obstruction resulting from upper airway edema and pneumonia. Once diagnosed, an inhalation injury should be treated with early intubation, aerosol therapy, and antibiotics as soon as possible. We should suspect this injury in circumstances involving fire and especially bomb attacks in a military setting. Antipersonnel landmines designed to damage the soldier by amputating the leg can cause blast injuries, but their power is limited to the lower extremity. However, we found an inhalation injury in a victim whose leg had been amputated by an antipersonnel landmine. As soon as we suspected an inhalation injury, we intubated the patient to preserve his airway and started acetylcysteine/heparin aerosol therapy. The patient also was treated with proper antibiotics for right lower lung pneumonia that developed as a sequela of inhalation injury. We could extubate the patient without any complications such as airway obstruction on the third day of intensive care, after which the patient was transferred to the general ward for active rehabilitation. This report presents the first known case of inhalation injury due to a landmine explosion.

Summary

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The Genesis of Long Bone Defects Resulting from Modern Combat Trauma: Part 1. Defect Localization
S. O. Guryev, S. V. Hariian, V. A. Kushnir, O. S. Soloviov, O. S. Tsybulskyi
The Ukrainian Journal of Clinical Surgery.2026; 93(4): 82. CrossRef

Review Article

Trauma Surgery and War: A Historical Perspective: Kun Hwang; J Trauma Inj. 2021;34(4):219-224. Published online September 7, 2021; DOI: https://doi.org/10.20408/jti.2021.0029

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Abstract PDF

The aim of this review is to introduce the progress in trauma surgery made during war. In the 16th century, Paré reintroduced ligature of arteries, which had been introduced by Celsus and Galen, instead of cauterization during amputation. Larrey, a surgeon in Napoleon’s military, adapted the “flying artillery” to serve as “flying ambulances” for rapid transport of the wounded. He established rules for the triage of war casualties, treating wounded soldiers according to the seriousness of their injuries and the urgency of medical care. To treat fractures and tuberculosis, Thomas created the “Thomas splint”, which was used to stabilize fractured femurs and prevent infection; in World War I (WWI), use of this splint reduced the mortality of compound femur fractures from 87% to less than 8%. During WWI, Cushing systematized the treatment of head injuries, reducing mortality among head injury patients. Gillies repaired facial injuries, and his experiences became the basis of craniofacial and aesthetic surgery. In WWII, McIndoe discovered that immersion in saline promoted burn healing and improved survival rates, and thus began saline baths and early grafting instead of using tannic acid. A high mortality rate in patients with acute renal failure was noted in WWII and the Korean War. In the Korean War, Teschan used the Kolff-Brigham dialyzer. The first use of medevac with helicopters was the evacuation of three British pilot combat casualties by the US Army in Burma during WWII. As a lotus blooms in the mud, military surgeons have contributed to trauma surgery during wartime.

Summary

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Kun Hwang
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Kun Hwang
Journal of Trauma and Injury.2022; 35(Suppl 1): S1. CrossRef

Original Articles

Epidemiology and Incidence of Orthopedic Fractures in the Military of the Republic of Korea: Sung Jin An, Sang Hyun Lee, Gi-Ho Moon; J Trauma Inj. 2021;34(1):50-56. Published online November 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0046

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Abstract PDF

Purpose

Fractures are common in the military population, but limited studies have investigated the incidence of fractures among Korean military personnel. Hence, this study aimed to clarify this issue.

Methods

Eligible subjects were patients who had sustained a fracture and were registered in the N-DEMIS (the medical records system of participating hospitals) from June 2017 to May 2019. Fractures were categorized according to the fracture site, patients’ age, sex, and type of duty.

Results

In total, 23,687 patients with 23,981 fractures were included. There were 216 patients with multiple fractures, of whom 156 had fractures at two sites, 42 had fractures at three sites, and 18 had fractures at four sites. Of the 23,687 patients, 23,340 were men and 347 were women. The incidence of fractures in men and women was 12.96 per 1,000 person-years and 0.19 per 1,000 person-years, respectively. In terms of the broad location of fractures, the percentage of fractures was the highest in the hand, followed by the foot and lower leg. When the location of fractures was analyzed more specifically, the percentage of fractures was the highest in the phalanx (thumb and fingers), followed by the ankle and metacarpal bones.

Conclusions

Hand, foot, ankle, and wrist fractures were the most commonly encountered fractures in the Korean military population. To prevent the loss of combat power due to non-battle-related injuries, thorough preparation is necessary, including protective equipment and preliminary training for areas with a high frequency of fracture occurrence.

Summary

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Physical Fitness Test Failure Risk Among Active-Duty Service Members With a History of Fracture
Cecelia O Brown, Brandon L Hillery, Kimberton K Porter, Daniel B Edgeworth, Jessica A White-Phillip, Tyler E Harris
Military Medicine.2026; 191(Supplement): 44. CrossRef
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Military Medicine.2026; 191(Supplement): 136. CrossRef
Evaluation of combat-related orthopaedic injuries: a comparative study of two military campaigns
Tal Shachar, E Yaacobi, A M Tsur, I Radomislensky, N Ohana, O Almog
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Hoyong Sung, Geon Hui Kim, On Lee, Jaewoo Kim, Kyoung Bae Kim, Hyo Youl Moon, Yeon Soo Kim
The Korean Journal of Sports Medicine.2024; 42(1): 1. CrossRef

Epidemiologic Analysis of Burns in Military Hospital: Jangkyu Choi, Sejin Park, Hyun Chul Kim; J Trauma Inj. 2017;30(4):145-157. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.145

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Abstract PDF

Purpose

We accessed epidemioloy of 908 acute burns (7 years) in the military, of injuries and propose proper educational programs to suit community.

Methods

We surveyed burn demographics, circumstances of injuries, size, result of treatment.

Results

The mean age was 20.6 years. The flame burns (FB) (325, 35.8%) were most common, followed scald (SB) (305, 33.6%), contact (CB) (219, 24.1%), electric (EB) (45, 5.0%) and chemical burns (ChB) (14, 1.5%). The more occurred during winter (29.7%). SB had mean 3.9% total body surface area (TBSA). The 251 (82.3%) had superficial burns by spillage of hot water/food on lower limbs (45.6%), feet (33.8%) in summer (34.8%), treated with simple dressing (92.8%). Morbidity rate was 5.6%; post traumatic stress disease (PTSD) (0.7%). FB had large wound (9.3% TBSA). The 209 (64.3%) had superficial burns by ignition to flammable oils (31.7%) and bomb powders (29.2%) on head/neck (60.3%), hands (58.6%) in summer (31.7%), autumn (30.2%). They underwent simple dressing (83.4%) and skin graft (16.0%). Morbidity rate was 18.8%; PTSD (10.5%), inhalation injuries (4.0%), corneal injury (3.7%), amputations (0.9%), and mortality rate (1.2%). CB had small (1.1% TBSA), deep burns (78.5%) by hotpack (80.4%) on lower limbs (80.4%). The more (59.8%) underwent skin graft. EB had 6.8% TBSA. The 29 (64.4%) had superficial burns by touching to high tension cable (71.1%) on hand (71.1%), upper limbs (24.4%) in autumn (46.8%). They underwent simple dressing (71.1%) and skin graft (24.4%). They showed high morbidity rate (40.0%); loss of consciousness (13.3%), nerve injuries (11.1%), neuropathy (8.9%), amputations (2.2%), and mortality rate (2.2%).

Conclusions

The cook should wear apron over the boots during work. The lighter or smoking should be strictly prohibited during work with flammable liquids or bomb powders. Don’t directly apply hotpack to skin for a long time. Use insulating glove during electric work. Keep to the basic can prevent severe injury and proper education is important.

Summary

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The Immune and Regenerative Response to Burn Injury
Matthew Burgess, Franklin Valdera, David Varon, Esko Kankuri, Kristo Nuutila
Cells.2022; 11(19): 3073. CrossRef

Qualitative Analysis of the Tetanus Antibody in Korean Army personnel after Visiting a Tertiary Armed Forces Hospital: Chung Kwon Kim, Jong Hwan Shin; J Korean Soc Traumatol. 2007;20(2):65-71.

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Abstract PDF: PURPOSE
In the Korean armed forces, vaccination against tetanus is done when personnel join the military service, but we do not know how many military personnel are vaccinated and how many soldiers have protection against tetanus. We performed a qualitative analysis of the tetanus antibody in Korean military personnel by using the TQS (Tetanus Quick Stick) METHODS: This study used a prospective collection method for military personnel visiting to the emergency department of a tertiary armed forces hospital from July 2005 to January 2007. We performed an analysis by using the TQS and asked whether the personnel had been inoculated during military service.
RESULTS
The number of enrolled military personnel was 474. Among them, 412 had been vaccinated against tetanus after entering the military service. The positive rate of TQS was 91.3% (373 patients) after vaccination for tetanus.
CONCLUSION
Many military personnel were inoculated with tetanus toxoid during military service and have protective antibodies for tetanus. According as TQS should be used for military personnel who visit the emergency department of an armed forces hospital. Also, anti-tetanus immunoglobulin should not normally be used a positive TQS for tetanus prophylaxis.; Summary

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