Journal ArticleDOI
Ahead of the curve: Sustained innovation for future combat casualty care.
TLDR
Results from this analysis show that, as a percentage of all combat-related deaths during the course of the wars, 76% were in the prehospital setting, and that the work is not done to improve prehospital care and alleviate the burden of survivorship, resulting from effective lifesaving efforts.Abstract:
T figure on the cover of this issue of the Journal of Trauma and Acute Care Surgery illustrates concluding casualty statistics from the wars in Afghanistan and Iraq. While various reports on morbidity and mortality among US service personnel have been provided during earlier phases of the wars, this analysis represents the first since the conclusion of combat operations in December 2014. The percentage of died of wounds, killed in action, and overall case-fatality rate are based on data from the Defense Casualty Analysis System and calculated using accepted definitions of each of these percentages. The percentage of died of wounds, killed in action, and case-fatality rate of 2.4%, 7.1%, and 9.3%, respectively, provide important information for the Department of Defense Combat Casualty Care Research Program (CCCRP) and offer compelling context for the nation and its volunteer force. Results from this analysis also show that, as a percentage of all combat-related deaths during the course of the wars, 76% were in the prehospital setting. Although substantial, this value is less than the burden of prehospital mortality in Korea (91% of combat deaths) and Vietnam (88% of combat deaths) as well as that reported by Eastridge et al. in a 2011 analysis (87%). These new findings provide evidence that efforts to research and develop knowledge and materiel solutions, combined with an appropriately postured force structure and an integrated Joint Trauma System, are having an effect on mitigating prehospital mortality. These data also show that the work is not doneVthe gaps in combat casualty care are not resolvedVand further progress must be made to improve prehospital care and alleviate the burden of survivorship (i.e., in-hospital morbidity and mortality), resulting from effective lifesaving efforts. As the analysis of concluding statistics from the recent wars continues, the Department of Defense CCCRP enters a new era, one that has it endeavoring to stay ahead of the curve and spur innovation to support future andmore complex operational scenarios. Evenwith the end of combat operations in Afghanistan, the United States maintains a significant number of troops in the country to participate in Operation Resolute Support, a North Atlantic Treaty OrganizationYled mission to provide training and support to local institutions and forces. Simultaneously, the United States and partner nations have initiated Operation Inherent Resolve in northern Iraq and Syria, while continuing small-unit surveillance and targeted operations in parts of Africa. Finally, strategic guidanceVincluding the so-called pivot or rebalance of policy toward the Asia Pacific region as well as the Army Operating Concept ‘‘Force 2025 and Beyond’’ (AOC 2025B)Vinforms the research program working to develop solutions to support combat scenarios over large-distance operations in the Pacific and in highly populated urban areas (i.e., megacities). Although the scale and conduct of these operations are likely to be different from those of the past 14 years, US personnel will continue to serve in hostile and unpredictable environments around the world. In many ways, future operational scenarios may present greater challenges to casualty care than those of the past. In this context, future combat casualty caremay be tested by longer prehospital times requiring a reappraisal of the traditional ‘‘GoldenHour.’’ During the past decade, the GoldenHour has existed as a lifesaving and resuscitation capability based on predictable and enabled levels of care. However, future scenarios, including prolonged field care (PFC) and long-distance air-, landor sea-basedread more
Citations
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Journal ArticleDOI
Reexamination of a Battlefield Trauma Golden Hour Policy.
Jeffrey T. Howard,Russ S Kotwal,Alexis R. Santos-Lazada,Matthew J. Martin,Zsolt T. Stockinger +4 more
TL;DR: Reduction in KIA mortality is associated with early treatment capabilities, blunt mechanism, select body locations of injury, and rapid transport.
Journal ArticleDOI
Dismounted Complex Blast Injuries: A Comprehensive Review of the Modern Combat Experience
Jeremy W. Cannon,Luke J. Hofmann,Luke J. Hofmann,Sean C. Glasgow,Benjamin K. Potter,Carlos J. Rodriguez,Leopoldo C. Cancio,Todd E. Rasmussen,C. Anton Fries,Michael R Davis,Michael R Davis,James R. Jezior,Richard J. Mullins,Eric A. Elster +13 more
TL;DR: This paper is intended to help surgeons and their patients better understand the role of adrenaline in the development of traumatic brain injuries and how to treat these injuries more effectively.
Journal ArticleDOI
Saving the Military Surgeon: Maintaining Critical Clinical Skills in a Changing Military and Medical Environment
Journal ArticleDOI
The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq.
Russ S Kotwal,Laura L F Scott,Jud C. Janak,Bruce W. Tarpey,Jeffrey T. Howard,Edward L. Mazuchowski,Frank K. Butler,Stacy Shackelford,Jennifer M. Gurney,Zsolt T. Stockinger +9 more
TL;DR: Although data were limited, early blood transfusion was associated with battlefield survival in Iraq as it was in Afghanistan, and critical casualties had lower mortality when blood was received than other casualties.
Journal ArticleDOI
A National Trauma Care System to Achieve Zero Preventable Deaths After Injury: Recommendations From a National Academies of Sciences, Engineering, and Medicine Report
TL;DR: It is asserted that continued progress in trauma care capability and learning capacity will require better conduits for the continuous and seamless exchange of knowledge between the 2 sectors, and military and civilian trauma care and learning will be optimized together, or not at all.
References
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Journal ArticleDOI
Death on the battlefield (2001-2011): Implications for the future of combat casualty care
Brian J. Eastridge,Robert L. Mabry,Peter Seguin,Joyce Cantrell,Terrill Tops,Paul Uribe,Olga Mallett,Tamara Zubko,Lynne Oetjen-Gerdes,Todd E. Rasmussen,Frank K. Butler,Russ S Kotwal,John B. Holcomb,Charles E. Wade,Howard R. Champion,Mimi Lawnick,Leon E. Moores,Lorne H. Blackbourne +17 more
TL;DR: To significantly impact the outcome of combat casualties with PS injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battlefield point of injury and surgical intervention.
Journal ArticleDOI
Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004.
John B. Holcomb,Neil R. McMullin,Lisa Pearse,Jim Caruso,Charles E. Wade,Lynne Oetjen-Gerdes,Howard R. Champion,Mimi Lawnick,Warner D. Farr,Sam Rodriguez,Frank K. Butler +10 more
TL;DR: In this paper, a panel of military medical experts reviewed photographs and autopsy and treatment records for all Special Operations Forces (SOF) who died between October 2001 and November 2004 (n = 82). Fatal wounds were classified as nonsurvivable or potentially survivable.
Journal ArticleDOI
Understanding combat casualty care statistics
TL;DR: The objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre or post medical treatment facility care.
Journal ArticleDOI
An analysis of in-hospital deaths at a modern combat support hospital.
Matthew J. Martin,John S. Oh,Heather M. Currier,Nigel Tai,Alec C. Beekley,Matthew J. Eckert,John B. Holcomb +6 more
TL;DR: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage.
Journal Article
Causes of death in US Special Operations Forces in the global war on terrorism: 2001-2004.
John B. Holcomb,James L Caruso,Neil R. McMullin,Charles E. Wade,Lisa Pearse,Lynne Oetjen-Gerdes,Howard R. Champion,Mary M. Lawnick,Warner Farr,Sammy Rodriguez,Frank Butler +10 more
TL;DR: The majority of deaths on the modern battlefield are nonsurvivable, and no new training or equipment needs were identified for 53% of the potentially survivable deaths while improved methods of truncal hemorrhage control need to be developed for the remainder.