Page 90 - Journal of Special Operations Medicine - Fall 2017

Data Registries Table 1 Overall Demographics
Category % (No.)
PHTR description MOI
The JTS PHTR is a data collection and analytic system de-
signed to provide near real-time feedback to commanders. The Explosive 22.6 (14)
primary purposes of this system are to improve casualty visibil- GSW 74.2 (46)
ity, augment command decision-making processes, and direct GSW + explosive 3.2 (2)
procurement of medical assets. Additionally, this system seeks Affiliation
to improve morbidity and mortality through performance im- SOCOM 11.3 (7)
provement in the areas of primary prevention (i.e., tactics, tech- CON 15.5 (9)
niques, and procedures), secondary prevention (i.e., personal AFG 74.2 (46)
protective equipment), and tertiary prevention (i.e., casualty re- Injury class
sponse system and TCCC). Central Command and their Joint Battle injury 96.8 (60)
Theater Trauma System capture all prehospital trauma care Nonbattle injury 3.2 (2)
provided on the ground by all services in the Afghanistan The-
ater. TCCC cards, DD 1380 forms, and TCCC After-Action Evacuation priority
Reports (AARs) provide the registry data. The PHTR was in Urgent 88.7 (55)
existence from January 2013 to September 2014. Priority 6.5 (4)
Routine 4.8 (3)
DoDTR description Highest provider level a
The DoDTR, formerly known as the Joint Theater Trauma Medical officer 64.5 (40)
Registry, is the data repository for DoD trauma-related inju- Medic 24.2 (15)
ries. The DoDTR includes documentation regarding demo- Unknown 11.3 (7)
graphics, injury-producing incidents, diagnoses, treatments, AFG, Afghan; CON, conventional; GSW, gunshot wound; MOI,
and outcomes of injuries sustained by U.S./non-U.S. military mechanism of injury; SOCOM, Special Operations Command.
and U.S./non-U.S. civilian personnel in wartime and peacetime a Data fields were missing for seven patients.
from the point of injury to final disposition.
the chest. The majority (n = 46; 74.2%) were due to GSW;
the remainder were due to either explosive-based punctures
Data Collection
We collected data on vital signs, level of medical provider (n = 16; 25.8%) or to a combination of both GSW and explo-
training, painful procedures, medications administered, evacu- sives (n = 2; 3.2%). The mean (standard deviation [SD]) vital
ation status, mental status, mechanism of injury (MOI), and signs data were as follows: heart rate, 101.4/min (SD, 25.0/
battle injury versus nonbattle injury status. We used the first min); systolic blood pressure, 118.4mmHg (SD, 22.4mmHg);
set of recorded vital signs when multiple sets were available. respiratory rate, 22.4/min (SD, 7.3 min); and pulse oximetry,
To determine the medical provider, we recorded the highest 96.1% (SD, 4.3%). The median Glasgow Coma Scale score
level provider documented in the following order: medical of- was 14 (interquartile range, 11–15).
ficer, medic, nonmedic first responder. We pooled all Afghan
forces into a single category for the purpose of this analysis, to Of the 62 casualties with penetrating chest wounds, 46 (74.2%)
include military, federal, and local police. underwent chest seal placement. An additional 51 casualties
underwent chest seal placement without documentation of ac-
Identification of patients companying penetrating chest wounds; we excluded these ca-
Using the PHTR data, we searched for all patients with a sualties from data analysis as not meeting the inclusion criteria,
documented puncture or GSW to the chest. We then reviewed but the existence of this population may point to inadequate
battalion aid station AARs for documentation of efficacy or training or documentation.
malfunctions. We assumed chest tube placement occurred after
the placement of the chest seal and/or needle decompression. Documented chest-seal brand use was as follows: HALO (n = 20,
43.5%; Chinook Medical Gear, http://www.chinookmed.com;
Data Analysis Figure 1); HyFin (n = 7, 15.2%; North American Rescue, https://
We performed all statistical analysis using Microsoft Excel (ver- www.narescue.com; Figure 2); H&H Medical (specific model not
sion 10; https://www.microsoft.com/en-us/) and SPSS (version documented; n = 1, 2.2%; https://buyhandh.com/; Figures 3 and
24; IBM, https://www.ibm.com/analytics/us/en/technology/spss/). 4), H&H Wound Seal (n = 1, 2.2%; Figure 4). No documenta-
Finally, we compared study variables between patients undergo- tion on brand existed for the remaining 17 encounters (37%).
ing chest seal placement versus no chest seal placement using a
Student t test for continuous variables, Wilcoxon rank-sum test Of the 46 patients with chest seals, there was documentation
for ordinal variables, and Χ test for nominal variables. on efficacy in only 32 cases. Of these, 29 (90.6%) were docu-
2
mented as effective, whereas three (9.4%) were documented
as ineffective.
Results
All patients were male. From January 2013 through September In the chest seal group (n = 46), 54.3% of patients (n = 25)
2014, there were 737 encounters (Tables 1 and 2). Of these, underwent chest tube (CT) or needle decompression (NCD)
24 casualties were killed in action, five were dead on arrival, after chest seal placement, 34.8% (n = 16) did not undergo
and three were enemy prisoners of war, all of whom were ex- CT or NCD, and documentation was insufficient in the rest of
cluded. Of the remaining 705 casualties, we identified 62 pa- the cases to determine other measures taken. In the group that
tients with documented GSW or puncture wound trauma to did not receive a chest seal (n = 16), 31.3% of patients (n = 5)

86 | JSOM Volume 17, Edition 3/Fall 2017