Page 83 - JSOM Summer 2018

TABLE 1 Characteristics of Study Population (N = 212), Flight, and The most common intervention during en route care was pa-
Providers tient monitoring (n = 101), followed by hemorrhage control
Medical (n = 5) Trauma (n = 207) (n = 67) and medications (n = 47; Table 3). Airway interven-
Characteristic No. (%) a No. (%) a tions provided during en route care (n = 31) were slightly more
Local or foreign common than those provided at the POI (n = 27). Tourniquets
national 0 (0) 15 (7) were applied less commonly during en route care (n = 11) than
Pediatric 0 (0) 3 (1) at the POI (n = 48).
Female sex 0 (0) 11 (5)
Time of flight, Discussion
mean ± SD; 19 ± 14.2; 11 (10–35) 16 ± 13.4; 13 (10–20)
median (IQR) The Wound Data and Munitions Effectiveness Team database
≤15 min 2 (67) 104 (71) was established during the Vietnam conflict to comprehen-
16-30 min 0 (0) 34 (23) sively evaluate casualties from that conflict. Of note is that Bel-
>30 min 1 (33) 9 (6) lamy highlighted information from this database through his
5
No. of casualties seminal article in 1984 on the causes of death in conventional
≤2 3 (75) 113 (55) land warfare. Specifically, Bellamy observed that the vast ma-
>2 1 (25) 94 (45) jority of combat casualties in Vietnam died before reaching an
Lowest provider type MTF, denoting a need for improved trauma care delivery in
the prehospital environment. He also stated, “The appropri-
Medic 4 (80) 183 (90) ately trained combat medic should be able to assume a posi-
Physician 1 (20) 12 (6) tion of importance equal to that of the combat surgeon.” 5
assistant
Physician 0 (0) 9 (4) Prompted by subsequent combat during Operation Gothic
Highest provider type Serpent in Somalia, Bellamy’s article was followed by another
Medic 4 (80) 157 (77) seminal article written by Butler et al. in 1996 entitled “Tacti-
6
Physician cal Combat Casualty Care in Special Operations.” The Butler
assistant 1 (20) 27 (13) et al. article established evidence-based guidelines for optimiz-
Physician 0 (0) 26 (13) ing prehospital combat trauma care. Since then, numerous
Medic only 4 (80) 157 (77) authors have contributed publications to the study of prehos-
More than one 0 (0) 26 (13) pital combat trauma care. Notably, the 75th Ranger Regiment
provider developed and established a novel prehospital trauma regis-
Mechanism of injury try from which they published multiple studies, including a
7
Gunshot wound — 89 (45) detailed analysis of their prehospital treatment practices and
Blast injury — 82 (41) subsequent casualty outcomes. 8
Other — 28 (14)
Body region injured Following the success of the Ranger example, the Joint Trauma
System also developed a prehospital trauma registry to capture
Head — 33 (16) prehospital data from throughout the DoD. 9,10 Some casualties
Neck — 7 (3) found in both of these registries may have been transported by
Face — 16 (8) the 160th SOAR; therefore, a few POI care and injury data
Chest — 35 (17) points included in our study may be found in those registries.
Abdomen — 25 (12) However, an overlap is preferred to an underlap in data. Re-
Upper extremity — 55 (27) gardless, it is important to initiate unit-based documentation,
Pelvis — 9 (4) data collection, and data analysis to facilitate internal perfor-
Lower extremity — 84 (41) mance improvement programs, because such programs have
Skin — 9 (4) the potential to capture lessons learned and unmask opportu-
8,11
No. of body nities for organizational growth.
regions, mean ± — 1.4 ± 0.6; 1 (1–2)
SD; median (IQR) The blast-wound category, which captures injuries from
Outcome, no./total (%) IEDs, grenades, rockets, and other explosive munitions, only
Lived 4/5 (80) 176/207 (85) accounted for 41% of traumatic injuries in our study. In con-
Stable 4/4 (100) 151/176 (86) trast, other studies of the Afghanistan and Iraq conflicts have
observed that 65%–78% of injuries are from blasts.
4,8,12–14
Unstable — 25/176 (14) The relatively fewer blast injuries and more gunshot wounds
Died 0/0 (0) 31/207 (15) in our article may represent differences in tactical mission
Killed in — 26/31 (84) b as well as the tactics, techniques, and procedures used to
action prosecute and support that mission. Most 160th SOAR mis-
Died of — 5/31 (16) sions were conducted at night in support of air assault forces
wounds performing primarily direct action raids, so small-arms fire
Unknown 1/5 (20) — encountered during these missions may account for more
IQR, interquartile range; SD, standard deviation. nocturnal injuries as compared with the myriad of other
a Unless otherwise indicated.
b Four fatalities were categorized as “Angel Flights” because they missions (e.g., ground assaults, convoy operations, security
passed away before casualty evacuation. patrols, logistics support, base operations) that occur during
the daytime and that may be more susceptible to incurring

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