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Citation
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Kotwal RS, Mazuchowski EL, Stern CA, Montgomery HR, Janak JC, Howard JT, Butler FK, Holcomb JB, Eastridge BJ, Gurney JM, Shackelford SA. J. Trauma Acute Care Surg. 2019; ePub(ePub): ePub. |
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Affiliation
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Defense Health Agency, Combat Support-Joint Trauma System, Joint Base San Antonio-Fort Sam Houston, Texas (Kotwal, Mazuchowski, Stern, Montgomery, Janak, Howard, Butler, Gurney, Shackelford); Uniformed Services University, Bethesda, Maryland (Kotwal, Mazuchowski, Gurney, Shackelford); Texas A&M University, College Station, Texas (Kotwal); Armed Forces Medical Examiner System, Defense Health Agency, Dover Air Force Base, Delaware (Mazuchowski); United States Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, Texas (Gurney); University of Texas, Houston, Texas (Holcomb); University of Texas, San Antonio, Texas (Howard, Eastridge). |
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Abstract
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BACKGROUND: Studies of fatalities from injury and disease guide prevention and treatment efforts for populations at risk.
FINDINGS can inform leadership and direct clinical practice guidelines, research, and personnel, training, and equipment requirements.
METHODS: A retrospective review and descriptive analysis was conducted of United States Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001 to September 10, 2018. Characteristics analyzed included subcommand, military activity, operational posture, and manner of death.
RESULTS: Of 614 USSOCOM fatalities (median age, 30; male 98.5%) the leading cause of death was injury (97.7%); specifically, multiple/blunt force injury (34.5%), blast injury (30.7%), gunshot wound (GSW; 30.3%), and other (4.5%). Most died outside the US (87.1%); during combat operations (85.3%); in the prehospital environment (91.5%); the same day of insult (90.4%). Most fatalities were with the US Army Special Operations Command (67.6%), followed by the Naval Special Warfare Command (16.0%), Air Force Special Operations Command (9.3%), and Marine Corps Forces Special Operations Command (7.2%). Of 54.6% who died of injuries incurred during mounted operations, most were on ground vehicles (53.7%), followed by rotary-wing (37.3%) and fixed-wing (9.0%) aircraft. The manner of death was primarily homicide (66.0%) and accident (30.5%), followed by natural (2.1%), suicide (0.8%), and undetermined (0.7%). Specific homicide causes of death were GSW (43.7%), blast injury (42.2%), multiple/blunt force injury (13.8%), and other (0.2%). Specific accident causes of death were multiple/blunt force injury (80.7%), blast injury (6.4%), GSW (0.5%), and other (12.3%). Of accident fatalities with multiple/blunt force injury, the mechanism was mostly aircraft mishaps (62.9%), particularly rotary-wing (68.4%).
CONCLUSIONS: Most USSOCOM fatalities died abroad from injury in the prehospital setting. To improve survival from military activities worldwide, leaders must continue to optimize prehospital capability and develop strategies that rapidly connect patients to advanced resuscitative and surgical care.Performance Improvement and Epidemiological, level IV.
Language: en |