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Citation
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Kotwal RS, Staudt AM, Mazuchowski EL, Gurney JM, Shackelford SA, Butler FK, Stockinger ZT, Holcomb JB, Nessen SC, Mann-Salinas EA. J. Trauma Acute Care Surg. 2018; 85(3): 603-612. |
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Affiliation
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United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, Texas (Kotwal, Staudt, Gurney, Nessen, Mann-Salinas); Department of Defense Joint Trauma System, Joint Base San Antonio-Fort Sam Houston, Texas (Kotwal, Mazuchowski, Gurney, Shackelford, Butler, Stockinger); Armed Forces Medical Examiner System, Dover Air Force Base, Delaware (Mazuchowski); Center for Translational Injury Research, UT Health, Houston, Texas (Holcomb). |
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Abstract
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BACKGROUND: Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data.
METHODS: A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014. Casualties were analyzed by mortality status and location of death (pre, intra, or post transport), military affiliation, transport time, injury type and mechanism, combat mortality index-prehospital (CMI-PH), and documented prehospital treatment.
RESULTS: Of 9,557 casualties (median age, 25.0; male 97.4%), most (95.1%) survived to transfer from Role 2 facility care. Military affiliation included US coalition forces (37.4%), Afghanistan National security forces (23.8%), civilian/other forces (21.3%), Afghanistan National police (13.5%), and non-US coalition forces (4.0%). Mortality differed by military affiliation (p<0.001). Among fatalities, most were Afghanistan National security forces (30.5%) civilian/other forces (26.0%), or US coalition forces (25.2%). Of those categorized by CMI-PH, 40.0% of critical, 11.2% of severe, 0.8% of moderate, and <0.1% of mild casualties died. Most fatalities with CMI-PH were categorized as critical (66.3%) or severe (25.9%); whereas, most who lived were mild (56.9%) or moderate (25.4%). Of all fatalities, 14.0% died prehospital (pre-transport 5.8%; intra-transport 8.2%) and 86.0% died at a Role 2 facility (post-transport). Of fatalities with documented transport times (median, 53.0 minutes), most (61.7%) were evacuated within 60 minutes.
CONCLUSIONS: Role 2 surgical team care has been an important early component of the battlefield trauma system in Afghanistan. Combat casualty care must be documented, collected, and analyzed for outcomes and trends to improve performance. LEVEL OF EVIDENCE: Performance Improvement and Epidemiological, level IV.
Language: en |