Page 86 - JSOM Summer 2018

helicopter transport of casualties in Afghanistan, Kotwal et colloquial or unit-specific terms. This unfamiliarity of terms
al. noted mean and median times interval from scene to MTF required a data dictionary to be constructed to ensure cor-
4
arrival of 28 and 17 minutes, respectively. In comparison, our rect categorization of interventions. This is a novice issue that
study depicted faster times for transport of trauma casualties can be obviated through a data dictionary, business rules,
during this same interval with mean and median times of 16 and abstractor training. Fortunately, guidance and assistance
and 13 minutes, respectively. Although it is reassuring that were provided to us in this respect from specialists at the Joint
the 160 SOAR evacuated casualties rapidly to hospitals and Trauma System who currently maintain the DoD Trauma Reg-
th
surgical care, flight medical personnel were probably task sat- istry. Now that the foundation of the 160th SOAR CASEVAC
urated and may not have had time to accomplish all required database has been established, data fields can be further re-
interventions during this time. In addition to conducting fined to permit advancement of future queries regarding treat-
comprehensive head-to-toe assessments, usually while wear- ments, comparisons between helicopter type, and many other
ing night-vision goggles, flight medical personnel needed to questions. The database will also serve as a historical record
check and reinforce previous treatments and initiate new or that can be referenced by providers to ensure realistic prepa-
advanced treatments and monitoring as time permitted. ratory training for combat and other contingency operations
during interwar periods.
From our study, an interesting finding was seen in 11 casual-
ties who received limb tourniquets that were applied initially Maintaining a CASEVAC database is important for quality as-
during en route care after flight medic assessments revealed surance and quality improvement initiatives because doing so
substantial extremity hemorrhage. One of these casualties was will help in development and maintenance of organizational
wounded on 160th SOAR aircraft by ground small-arms fire treatment standards and identification of deficiencies and areas
during infiltration to the mission objective. Although others for improvement. Successful treatment practices that improve
were also wounded by ground fire while on 160th SOAR air- casualty outcomes can also be identified and shared through-
craft, no others required a tourniquet. Of the 11 casualties out the medical community. However, within the military, the
who received initial limb tourniquets on 160th SOAR air- medical leadership at the battalion and brigade level is often
craft, one ultimately died of wounds at an MTF. Although transient, and quality assurance or quality improvement prac-
it is optimal to apply tourniquets and control hemorrhage tices are frequently overshadowed by other priorities of effort.
immediately after an injury occurs, it can prove challenging Thus, to ensure a continuous state of organizational perfor-
for air and ground forces to identify and appropriately treat mance improvement, medical and nonmedical leadership must
all wounds during nighttime combat operations. Regardless, integrate these practices through policy and procedures.
this finding reinforces the need for flight medical personnel
to conduct comprehensive head-to-toe assessments as soon as Conclusion
casualties are loaded onto the aircraft by ground personnel. As
time permits, comprehensive serial assessments performed by Performance improvement efforts directed toward prehospital
all prehospital providers in the continuum of care will help to treatment of combat casualties have the potential to positively
mitigate harm and missed injuries. and markedly influence battlefield morbidity and mortality.
Documentation of care is a requisite for conducting perfor-
For our CASEVAC database, availability of more data and mance improvement; therefore, medical and nonmedical lead-
details on fatalities would have proved helpful in eliminating ers must mandate and enforce this documentation. Capturing
preventable death, through mortality analysis, trends, and com- and analyzing data from individual combat missions, as well
parisons. In addition to prehospital casualty cards, Kotwal et as multiple combat missions in aggregate, can help refine tac-
al. used Purple Heart records, medical records, DoD Trauma tics, techniques, and procedures, and more accurately define
8
Registry data, and Armed Forces Medical Examiner autopsy wartime personnel, training, and equipment requirements. Al-
records to analyze casualty injuries and wounding patterns, though limited, this novel dataset and its analysis are initial
establish injury severity scores, and determine cause of death. examples of how documentation, data collection and analysis,
For US patients in the CASEVAC database, follow-on efforts and performance improvement can be accomplished by a non-
should include using data from the DoD Trauma Registry and medical unit conducting CASEVAC missions.
Armed Forces Medical Examiner autopsies to increase fidel-
ity of injury data, assign injury severity scores, and determine Dedication
cause of death to improve performance and compare morbidity This article is dedicated to SFC Marcus V. Muralles and SSG
and mortality outcomes and findings between studies. Shawn H. McNabb, 160th SOAR Special Operations combat
medics who were killed in action in Afghanistan on 28 June
However, notable is that no other individual tactical ground 2005 and 26 October 2009, respectively.
force has documented care, consolidated data, and replicated a
comprehensive unit-based study and publication as have Kotwal Previous Presentation
et al. Also notable is that no individual CASEVAC unit (air or The abstract of this study was presented as a poster at the
8
ground) has documented care, consolidated data, and published Special Operations Medical Association Scientific Assembly,
a unit-based study, until this current study. Although comparing Charlotte, North Carolina, May 2016.
data from a tactical ground unit to that of a tactical air unit
has its limitations, comparing study methodologies will help im- Funding
prove future unit-based performance improvement efforts. No funding was received for this project.

During the initial stage of our study, it was noted that infor- Disclaimer
mation and data variability occurred between data analysts The views, opinions, and findings contained in this article are
because of a lack of understanding or unfamiliarity with those of the authors and should not be construed as official or

84 | JSOM Volume 18, Edition 2/Summer 2018