Page 82 - JSOM Summer 2018

perform en route care. In contrast, CASEVAC unit transports FIGURE 1 Flow diagram for study population available for detailed
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have been defined as designated or nondesignated, nondedi- analysis.
cated, and unregulated prehospital patient-transfer platforms
used by a nonambulance unit that may or may not have med-
ical personnel and medical equipment assets to provide en
route care. Usually, MEDEVAC platforms are marked with a
3
red cross and CASEVAC platforms are not.
Given that patients on the battlefield benefit from rapid trans-
port and en route care, this study proposed to analyze after
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action reviews (AARs) and characterize patients who under-
went CASEVAC as provided by 160th SOAR rotary-wing air-
craft. These CASEVAC data will establish a baseline for future
reference and will help guide protocols and procedures, train-
ing and equipping initiatives, and research efforts.

Methods
Approval for this project was obtained from the 160th Regi-
mental Commander and the University of Texas Institutional were 15 local nationals (7%), six of whom were male and
Review Board. It was determined that this project qualified as nine were female. Three wounded children (one boy, two girls)
nonregulated research. A retrospective review and descriptive also were transported. For this analysis, enemy wounded were
analysis were performed on 129 separate CASEVAC missions included in the local national category because sometimes
conducted by the 160th SOAR in Afghanistan from January their affiliation status was unclear. In addition to the nine lo-
2008 through May 2015. Descriptive statistics were used to cal national women, there were two female US military casu-
analyze data for 227 casualties who were transported from alties attached to Special Operations units, for a total of 11
the point of injury (POI) to an established medical treatment women transported. Both US female Soldiers were categorized
facility (MTF). as killed in action (KIA; died before reaching a MTF) as a
result of improvised explosive devices (IEDs). All CASEVAC
Original data were in narrative AAR format as documented missions conducted for medical reasons were for US and coa-
in near real time by the medic or medical officer who treated lition male Soldiers.
the patients. Unclassified, nonpersonally identifiable medical
data were extracted from the AARs and consolidated into a Table 1 shows the average time of flight for medical and for
database for detailed analysis. Data points extracted included trauma patients was less than 20 minutes. The time of flight
demographics (i.e., affiliation, sex); time of flight (from injury was broken down into medical and trauma, with median
scene to MTF arrival); number and type of medical provider CASEVAC times of 11 and 13 minutes, respectively. In this
(i.e., medic, physician assistant, physician), mechanism of in- dataset, total time from initial injury to arrival at a MTF was
jury (i.e., gunshot wound, blast, other), body region injured; not captured. Rather, the time of flight recorded was only for
outcome (i.e., lived, died); and medical interventions provided the time from injury-scene departure to arrival at the nearest
by ground-force nonmedical and medical personnel, as well appropriate facility (i.e., a small Role 2 MTF may have been
as CASEVAC medical personnel. Data were abstracted from overflown to go to a more robust Role 3 MTF with a neu-
AARs by a 160th SOAR physician who was intimately fa- rosurgeon). Additionally, findings also show that one flight
miliar with the unit and the unit’s missions. Raw data were medic was the most common number and type of medical pro-
organized in accordance with an established data dictionary vider for 160th SOAR CASEVAC flights.
(Appendix A). In cases where data were unclear, the author
of the AAR was queried to provide additional detail and clar- Table 1 also displays patient injury data and patient outcomes
ity. The final database was evaluated in conjunction with the after CASEVAC. Injuries to the extremities (n = 139; 67%)
En Route Care Division of the US Army Institute of Surgical were seen most commonly. The primary mechanisms of injury
Research. Data analysis was performed using JMP software, were gunshot wound (n = 89; 43%) and blast injury (n = 82;
version 10 (SAS Institute, https://www.sas.com). 40%); however, the incidence of these mechanisms was not
statistically different (p = .55). For those who incurred trauma,
there was a 15% (n = 31) mortality rate. Of those who died,
Results
most were KIA—they died before reaching a MTF and surgical
There were 227 individual CASEVAC cases reviewed, of care (26 of 31; 84%); the remainder of the trauma fatalities
which eight were military working dogs, four had unknown (five of 31; 16%) were categorized as having died of wounds,
injuries or illnesses, and three had minimal data. These 15 because they died after reaching a MTF and surgical care.
casualties were excluded from further analysis. Thus, the fi-
nal study population consisted of 212 patients, as depicted in The most common treatments provided at the POI were for
Figure 1. Trauma (n = 207; 98%) was the primary reason for hemorrhage control (n = 141) and medication administra-
conducting these CASEVAC missions, followed by other med- tion (n = 113; Table 2). Of hemorrhage control interventions,
ical reasons (n = 5; 2%). dressings or gauze were used most frequently. Of medications,
analgesics (particularly fentanyl) were administered most fre-
US, Afghanistan, and coalition military forces comprised most quently. Of note, only 17% (n = 35) of trauma casualties were
of the transported trauma casualties (n = 189; 91%). There transferred with POI care documented on a TCCC Card.

80 | JSOM Volume 18, Edition 2/Summer 2018