Page 48 - JSOM Spring 2020

on trauma patients with data ranging from January 2007 to
August 2017. 15–17 The US Army Institute of Surgical Research
(USAISR) regulatory office reviewed protocols H-16-005 and
H-17-020 and determined they were exempt from institutional
review board oversight. We obtained only deidentified data.

DoDTR Description FIGURE 1 French FDP kit.
The DoDTR, formerly known as the Joint Theater Trauma
Registry (JTTR), is the data repository of trauma-related in- (Courtesy of USAMMDA Public Affairs.)
juries for the DoD. 18-22 The DoDTR includes documentation
regarding demographics, injury-producing incidents, diagno-
ses, treatments, and outcomes following injuries. The registry
includes US/non-US military and US/non-US civilian personnel
from the point of injury to final disposition during war and
peacetime. The DoDTR consists of patients admitted to a Role
3 (fixed-facility) or forward surgical team (FST) with an injury
diagnosis using the International Classification of Diseases,
9th Edition (ICD-9) between 800-959.9, near-drowning/
drowning with associated injury (ICD-9 994.1) or inhalational mechanisms, as that makes up the bulk of combat injuries seen
17
injury (ICD-9 987.9), and trauma occurring within 72 hours in deployed military treatment facilities. The mortality rate in
from presentation to a facility with surgical capabilities. this cohort was about 1:11, which corresponds to the reported
in-hospital mortality rate for transfused and admitted coali-
23
Analysis tion forces in Iraq. In this series of cases, we summarize the
We performed all statistical analysis using Microsoft Excel history of FDP use by US forces during the chaos of combat.
(version 10, Redmond, WA) and JMP Statistical Discovery
from SAS (version 13, Cary, NC). We used descriptive meth- Previous studies have examined the effectiveness of FDP to
ods for reporting on the cases. We defined a massive transfu- treat coagulopathy as compared with FFP showing similar
sion as at least 10 units of packed red blood cells and/or whole efficacy. Other studies on the use of FDP in a combat set-
24
blood within the first 24 hours. ting are limited, with the only in depth analyses coming from
French forces in Afghanistan. However, the results from this
25
study were especially comparable to ours. Although a larger
Results
cohort was examined, the mechanisms of injury and rate of
Within our two datasets, we identified 11 cases of FDP use by mortality examined in the cohort that received FDP were akin
US forces. The median patient age was 28 years (interquartile to those seen in our study, further contributing to the French
range [IQR] 25–31 years), and patients were most frequently summarization of FDP use. Additionally, the ease of use of
male, part of Operation Enduring Freedom, of US military FDP was reported, attributing this to the short reconstitution
affiliation, and injured by explosive or gunshot wound. The time and convenience of the product. 26
median injury severity score was 21 (IQR 17–33), and most
did not receive a massive transfusion and survived to hospital While our study provides early examination into the use of
discharge (Table 1). FDP by US forces, most frequently Special Operations Forces
(SOF), but by virtue of the access restrictions, these case data
are limited, and ongoing surveillance is warranted. Under-
Discussion
standing the environments in which FDP is used most often by
Our study identified 11 cases of reported FDP use by US US forces and medical personnel’s familiarity with the product
coalition forces. Expectedly, those receiving FDP were most can be used to inform predeployment training as FDP contin-
likely to have been injured by gunshot wound or explosive ues to expand in the combat setting. Although the product

TABLE 1 Description of Casualties Who Received FDP for Trauma-Related Injuries
Military Mechanism of Injury Massive
Age (y) Sex Operation Patient Affiliation Injury Severity Score Transfusion Outcome
21 Male OIR Partner force GSW 10 No Alive
26 Male OEF US military Explosive 21 Yes Alive
25 Male OEF Coalition Explosive 45 Yes Alive
31 Female OEF Humanitarian GSW 20 No Alive
31 Male OEF US military GSW 25 No Dead
24 Male OEF US military Explosive 45 Yes Alive
30 Male OEF Partner force Blunt NOS 17 No Alive
27 Male OEF Humanitarian Explosive 17 No Alive
45 Male OEF Humanitarian GSW 30 No Alive
45 Male OFS US government Explosive 33 Yes Alive
28 Male OFS US military GSW 17 No Alive
OIR, Operation Inherent Resolve; OEF, Operation Enduring Freedom; OFS, Operation Freedom’s Sentinel; GSW, gunshot wound; NOS, not
otherwise specified.

44 | JSOM Volume 20, Edition 1 / Spring 2020