Page 62 - JSOM Winter 2019

individual casualty reports, hospital discharge summaries, FIGURE 2 ANASOC combat death by mechanism of injury (March
and disability assessments. While the latter two are one-page to December 2018).
medical reports from the 400-bed national military hospital in
Kabul, the individual casualty reports are administrative re-
ports that provide the mechanism of injury and whether the
injury occurred in combat. The hospital discharge summaries
provided minimal information limited to location of injury
and time of convalescence. The disability assessments were
occasionally more thorough but included only approximately
3% of casualties. All reporting was deidentified on translation
from Dari to English. To the knowledge of the authors, these
collected documents were the extent of all medical documenta-
tion and reporting throughout the ANASOC enterprise.

Injury and Level of Care Categories
This report defines killed in action (KIA) as any death at the
hands of hostile forces, further subcategorized as those who
died on the battlefield and those who died of wounds (DOW)
after transport off the battlefield. Wounded in action (WIA)
refers to a soldier with any wound received at the hands of
hostile forces. Injury categories were taken directly from the
individual casualty reports as one of the following: gunshot
wound, blast injury, mortar injury, RPG injury, or unspecified/
other. Given the limited information contained in the hospital FIGURE 3 ANASOC WIA by severity proxy (March to December
discharge summaries and disability assessments, these reports 2018).
were used simply to categorize patients by level of care because
ANASOC transfers the most severely wounded soldiers to the
400-bed hospital in Kabul, which is the only military hospital
capable of processing disability.

Data Analysis
The analysis of the data is limited to descriptive statistics of
the sample population. This publication will limit itself to ag-
gregate data that does not specifically include the total number
of casualties. This limitation is in the interest of operational
security with the publication having been reviewed by the
CJSOTF-A Intelligence Section.

Results
The majority of ANASOC deaths were combat related, des-
ignated KIA here. Approximately 10% of ANASOC deaths
were noncombat deaths which were not included. The mech-
anism of injury for KIA combat deaths is represented in Fig-
ure 2. The majority of combat deaths occurred from gunshot
wounds at 63% with blast injuries following in order of inci-
dence at 14%. Although there was no consistent mechanism
for reporting the timeline of ANASOC KIA combat deaths,
only approximately 3% of reports indicated that death oc-
curred at the hospital, which would be classified as DOW. minor injuries. Disability processing is, therefore, a stronger
It is possible that ANASOC underreported hospital deaths metric for severity because ANASOC reserves disability only
given the limitations of the system, but an approximate 97% for soldiers who can no longer add value to the organization
prehospital death rate is consistent with observations of the as determined by the commander.
CJSOTF-A Operations Section during the same time period.
Discussion
Figure 3 demonstrates that approximately 20% of total com-
bat WIA injuries led to admission to the national 400-bed Given the relatively few cases of ANASOC WIA with long-
military hospital. Approximately 3% of total combat WIA term sequelae, decreasing the number of combat deaths should
injuries resulted in disability processing, and the majority of be the driving goal for improving medical training. Comparing
these disability assessments were amputations from blast in- mechanism of injury for ANASOC KIA to other combat stud-
juries. The authors present the number of admissions to the ies helps judge the validity of the data while appreciating dif-
400-bed hospital as a proxy for severity; however, this metric ferences between regional conflicts. Eastridge et al. reported
1
will overestimate the number of severe injuries because the mechanism of injury for US deaths in Iraq and Afghanistan
400-bed hospital has its own catchment area that will include from 2001 to 2011 and noted 74% of combat deaths from

60 | JSOM Volume 19, Edition 4 / Winter 2019