Page 81 - JSOM Summer 2018

Survey of Casualty Evacuation Missions Conducted by the 160th Special
Operations Aviation Regiment During the Afghanistan Conflict

Theodore T. Redman, MD, MPH *; Kevin E. Mayberry, PA ;
2
1
3
4
Alejandra G. Mora, BS ; Brock A. Benedict, DO ; Elliot M. Ross, MD, MPH ;
5
Julian G. Mapp, MD, MPH ; Russ S. Kotwal, MD, MPH 7
6

ABSTRACT
Background: Historically, documentation of prehospital com- data from combat missions can help refine tactics, techniques,
bat casualty care has been relatively nonexistent. Without and procedures and more accurately define wartime person-
documentation, performance improvement of prehospital care nel, training, and equipment requirements. This study is an ex-
and evacuation through data collection, consolidation, and ample of how performance improvement can be initiated by a
scientific analyses cannot be adequately accomplished. During nonmedical unit conducting CASEVAC missions.
recent conflicts, prehospital documentation has received in-
creased attention for point-of-injury care as well as for care Keywords: casualty evacuation; CASEVAC; en route care;
provided en route on medical evacuation platforms. However, Tactical Combat Casualty Care; TCCC
documentation on casualty evacuation (CASEVAC) platforms
is still lacking. Thus, a CASEVAC dataset was developed and
maintained by the 160th Special Operations Aviation Regiment Introduction
(SOAR), a nonmedical, rotary-wing aviation unit, to evaluate
and review CASEVAC missions conducted by their organiza- The 160th Special Operations Aviation Regiment (SOAR) is
tion. Methods: A retrospective review and descriptive analysis a nonmedical combatant aviation unit that provides precision
were performed on data from all documented CASEVAC mis- rotary-wing support to conventional and Special Operations
1
sions conducted in Afghanistan by the 160th SOAR from Jan- Forces. Missions include attack, assault, and reconnaissance,
uary 2008 to May 2015. Documentation of care was originally which are usually conducted at night, at high speeds and low
performed in a narrative after-action review (AAR) format. altitudes, and on short notice. As a part of their mission, the
Unclassified, nonpersonally identifiable data were extracted 160th SOAR also performs casualty evacuation (CASEVAC)
and transferred from these AARs into a database for detailed for those who are injured during training, combat, and other
analysis. Data points included demographics, flight time, pro- contingency operations.
vider number and type, injury and outcome details, and med-
ical interventions provided by ground forces and CASEVAC A medical provider, typically a flight medic, is an integral mem-
personnel. Results: There were 227 patients transported during ber of the 160th SOAR aircraft crew for every mission as a con-
129 CASEVAC missions conducted by the 160th SOAR. Three tingency in the event there are casualties incurred by ground
patients had unavailable data, four had unknown injuries or ill- forces who need to be evacuated to a higher level of care. Within
nesses, and eight were military working dogs. Remaining were the 160th SOAR, medics are well versed in Tactical Combat
207 trauma casualties (96%) and five medical patients (2%). Casualty Care (TCCC) and prehospital trauma life support, and
The mean and median times of flight from the injury scene to receive paramedic-level training as Special Operations combat
hospital arrival were less than 20 minutes. Of trauma casual- medics. Additionally, these medics receive critical care flight
ties, most were male US and coalition forces (n = 178; 86%). paramedic training and certification. There are also unit med-
From this population, injuries to the extremities (n = 139; ical officers, physicians, and physician assistants, who periodi-
67%) were seen most commonly. The primary mechanisms of cally will be a part of the crew on these missions. However, use
injury were gunshot wound (n = 89; 43%) and blast injury (n = of these officers depends on the mission and their availability.
82; 40%). The survival rate was 85% (n = 176) for those who
incurred trauma. Of those who did not survive, most died be- Tactical or prehospital transport of patients has historically
fore reaching surgical care (26 of 31; 84%). Conclusion: Per- been categorized by the Department of Defense (DoD) as ei-
formance improvement efforts directed toward prehospital ther medical evacuation (MEDEVAC) or CASEVAC. Con-
2
combat casualty care can ameliorate survival on the battlefield. ventional MEDEVAC unit transports have been defined as
Because documentation of care is essential for conducting per- designated, dedicated, and regulated or unregulated prehos-
formance improvement, medical and nonmedical units must pital patient-transfer platforms used by an ambulance unit
dedicate time and efforts accordingly. Capturing and analyzing that has medical personnel and medical equipment assets to
*Correspondence to 3156 Carrie Taylor Circle, Clarksville, TN 37043; or ted20878@yahoo.com.
1 Dr Redman is with the 160th Special Operations Aviation Regiment, Ft Campbell, Kentucky; and Prehospital Research and Innovation in Mil-
2
itary and Expeditionary Environments (PRIME2) Research Group. Mr Mayberry is at the San Antonio Uniformed Services Health Education
Consortium, Joint Base San Antonio–Fort Sam Houston, Texas. Ms Mora is at US Army Institute for Surgical Research, Enroute Care Division,
3
5
Joint Base San Antonio–Fort Sam Houston. Dr Benedict is with the 160th Special Operations Aviation Regiment. Dr Ross is with PRIME2; and
4
San Antonio Fire Department, Office of the Medical Director, San Antonio, Texas. Dr Mapp is with PRIME2; US Army Institute for Surgical
6
Research, Enroute Care Division, Joint Base San Antonio–Fort Sam Houston; and San Antonio Fire Department, Office of the Medical Director.
7 Dr Kotwal is at Department of Defense Joint Trauma System, Joint Base San Antonio–Fort Sam Houston.
79