Page 146 - Journal of Special Operations Medicine - Spring 2017

Methods one for lack of sufficient patient care details, three for
medical diagnoses that did not require urgent medical
This study was approved as a performance improvement evacuation (MEDEVAC), and one that described a mass
project by the Department of Defense Joint Trauma System.
casualty incident with hundreds of patients without
means to adequately describe individual patient treat-
A survey instrument was developed in order to afford ment. Remaining were cases describing 54 patients from
respondents with the ability to transcribe data from 41 separate MEDEVAC missions. The majority (96.3%;
after-action reviews (AARs) in a standardized and uni- 52/54) were male with the exception of two female chil-
form manner while also excluding classified or sensitive dren. Ages ranged from 1 to 60 years with a mean age of
information. The instrument permitted input of basic 32.5 years and median of 30 years (SD 15 years). Cases
patient demographics, patient care environmental de- were distributed between patient categories to include
scriptors, medical provider training, modes of transpor- 50.0% (27/54) US military, 22.2% (12/54) local civilian
tation, patient injuries and mechanism of injury, vital and non-NATO military members, and 27.8% (15/54)
signs, treatments rendered, equipment and resources not specified (Table 1).
used, duration of PFC, and morbidity and mortality
status upon delivery to the next level of care. Addition- Table 1 Patient Demographics
ally, there were four open-ended questions for reporting
equipment failures and shortfalls, lessons learned, and No. (%)
training deficiencies. Male 52 (96.3)
Age (y); mean (SD) 32.5 (15)
For this study, PFC is defined as any Role 1 or prehos- Range (y) 1–60
pital event that lasted longer than 4 hours and required
evacuation of the patient to a higher level of medical US military 27 (50.0)
care, regardless of whether the patient died before or Army 8 (14.8)
during transport. Patients with traumatic injuries, as Marines 6 (11.1)
well as surgical and medical illnesses, were included in Air Force 4 (7.4)
the study. Role 1 events included those that occurred on
and off of the battlefield, to include a casualty collection Navy 2 (3.7)
point, aid station, clinic, ship, or any other prehospital Not specified 7 (13.0)
environment where surgical care and advanced resusci- Non-NATO military 1 (1.9)
tation teams were not available. Civilian 7 (13.0)
Other/not specified 19 (35.2)
Surveys were advertised on the PFC website and distrib-
uted to members of the PFC working group as well as to Combatant command
US military medical providers from Special Operations, AFRICOM 20 (37.0)
search and rescue, and submarine teams. The Special PACOM 15 (27.8)
Operations Combat Medical Skills Sustainment Course
website was also reviewed for PFC cases. The survey was CENTCOM 11 (20.4)
8
voluntary, and responses were collected and deidentified USNORTHCOM 3 (5.6)
through assignment of a unique serial identification num- Not specified 5 (9.3)
ber. Deidentified data were then transcribed into a Micro-
soft Excel spreadsheet for tabulation and basic analysis.
PFC Factors
Regions of care were categorized by combatant com-
Descriptive statistics were used to characterize the AAR mand. Of 49 cases identifying a combatant command,
data. Simple sums and percentages were used to quan- 40.8% (20/49) were in AFRICOM, 30.6% (15/49) were
tify patient demographics (age, sex, military affiliation), in PACOM, 22.4% (11/49) were in CENTCOM, and
care locations, factors influencing PFC duration, mecha- 6.1% (3/49) were in NORTHCOM (Table 1). When
nisms and injuries, provider skillsets, equipment utiliza- further categorizing the environment, 96.3% (52/54) of
tion, and morbidity and mortality.
cases were identified as occurring in remote or austere
locations. Of these austere cases, 36.5% (19/52) were
in mountainous regions, 28.8% (15/52) were in a des-
Results
ert environment, 19.2% (10/52) were in a maritime set-
Patient Demographics ting, 13.5% (7/52) occurred in a jungle environment,
A total of 59 surveys were received describing patients and 7.7% (4/52) were in an urban setting. Aside from
treated during 46 missions from December 2001 to June the austere setting of the majority of these cases, other
2016. Of these surveys, five were excluded from analysis: operational factors contributed to the need for PFC in

122 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017