Page 147 - Journal of Special Operations Medicine - Spring 2017

23 cases. In these cases, care was primarily extended due Table 3 Patient Injuries and Illnesses
to enemy activity (73.9%; 17/23) and weather (13.0%; No. (%)
3/23), with snow being the contributing element for each
weather incident. Additionally, aircraft mechanical prob- Injury classification
lems, lack of night-vision and night-flying capability, and Life-threatening injuries and illnesses 36 (66.7)
ground force need to complete mission objectives were Limb or eyesight threatening 8 (14.8)
also mentioned as contributing factors for PFC (Table 2). Non–life/limb/eye threatening 10 (18.5)
Table 2 Factors Contributing to PFC Mechanism category

No. (%) Battle injury 17 (31.5)
Enemy activity 17 (31.5) Nonbattle injury 18 (33.3)
Care under fire 13 (24.1) Medical illness 19 (35.2)
Weather (snow) 3 (5.6) Mechanism of injury (35 injured patients)
Aircraft mechanical issues 1 (1.9) Penetrating 20 (57.1)
No night flying capability 1 (1.9) Gunshot wound 15 (42.9)
Remote location 52 (96.3) Other 5 (14.3)
Mountainous 19 (35.2) Blunt 9 (25.7)
Desert 15 (27.8) Motor vehicle crash 5 (14.3)
Maritime 10 (18.5) Other 4 (11.4)
Jungle 7 (13.0) Burn 6 (17.1)
Urban 4 (7.4 Blast 3 (8.6)
Need to complete mission objectives 1 (1.9) Unspecified 1 (2.9)
Injuries (35 injured patients)
Gunshot wound 15 (42.9)
Patient Categories Traumatic brain injury 6 (17.1)
Patient injury or illness acuity was documented for all
54 cases, with life-threatening injuries or illnesses pres- Laceration 6 (17.1)
ent in 66.7% (36/54) of cases. Patients identified as hav- Burn 6 (17.1)
ing limb- or eyesight-threatening problems accounted % TBSA, mean (SD) 54 (29)*
for 14.8% (8/54) of cases, and the remaining 18.5% Range (% TBSA) 15–80
(10/54) of cases were without threat to life, limb, or eye-
sight. Battle injuries were incurred by 31.5% (17/54) of Fracture 4 (11.4)
patients, while nonbattle injuries and medical illnesses Thoracic or lumbar spine injury 3 (8.6)
accounted for 33.3% (18/54) and 35.2% (19/54) of pa- Blunt abdominal injury 2 (5.7)
tients, respectively (Table 3).
Blunt thoracic injury 1 (2.9)
Pathologies Encountered Active bleeding 15 (42.9)
For mechanism, penetrating injuries (37.0%; 20/54) Shock 10 (28.6)
were most prevalent among all cases, with gunshot *Four of six had estimates of total body surface area (TBSA).
wounds accounting for the majority (75.0%; 15/20) of
these injuries. Burns, motor vehicle crashes, and blast injury (2.9%; 1/35). Active bleeding was present in
injuries accounted for 11.1% (6/54), 9.3% (5/54), and 42.9% (15/35) of cases and 28.6% (10/35) were identi-
5.6% (3/54) of cases, respectively. The remainder of fied as being in shock. Of the six burn patients, four had
injury mechanisms (18.5%; 10/54) included three bear estimated total body surface area burn recorded with
maulings, two head injuries, one fall, one shrapnel in- a range of 15% to 80% and an average burn area of
jury, one aircraft crash, one chainsaw laceration, and 53.8% (Table 3).
one unspecified (Table 3).
Of medical illnesses (35.2%; 19/54) encountered, 42.1%
Traumatic injuries (64.8%; 35/54) were identified as (8/19) were abdominal, 42.1% (8/19) were infectious,
gunshot wounds (42.9%; 15/35), traumatic brain injury 5.3% (1/19) was cardiac, and 10.3% (2/19) were other
(17.1%; 6/35), laceration (17.1%; 6/35), burn (17.1%; etiologies. The abdominal pathologies consisted of four
6/35), fracture (11.4%; 4/35), back injury (8.6%; 3/35), cases of internal bleeding, two cases of appendicitis and
blunt abdominal injury (5.7%; 2/35), and blunt thoracic two cases of acute abdomen. The infections etiologies

Review of 54 Cases of Prolonged Field Care 123