@article{ref1,
title="En-route care capability from point of injury impacts mortality after severe wartime injury",
journal="Annals of surgery",
year="2013",
author="Morrison, Jonathan J. and Oh, John and Dubose, Joseph J. and Oʼreilly, David J. and Russell, Robert J. and Blackbourne, Lorne H. and Midwinter, Mark J. and Rasmussen, Todd E.",
volume="257",
number="2",
pages="330-334",
abstract="OBJECTIVE:: The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability. BACKGROUND:: Following a decade of war in Afghanistan, the impact of en-route care capabilities from the POI on mortality is unknown. METHODS:: Casualties evacuated from POI to one level III facility in Afghanistan (July 2008-March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins. RESULTS:: Most casualties (n = 1054; 61.2%) were in the low-ISS (1-15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16-50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51-75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 ± 77 vs 113 ± 122; P = 0.013) but there was no difference in mortality. CONCLUSIONS:: This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.<p /> <p>Language: en</p>",
language="en",
issn="0003-4932",
doi="10.1097/SLA.0b013e31827eefcf",
url="http://dx.doi.org/10.1097/SLA.0b013e31827eefcf"
}