Page 100 - 2022 Spring JSOM

Additionally, the mean age of death was 10 years in their study. recorded for both traumatic and nontraumatic injuries were
This indicates that many MWD deaths were due to older age, classified into analgesic, antibiotic, sedative, other medication,
rather than a combat-related injury. Reeves et al. examined 11 IV fluids, surgery, casts and splints, blood transfusion, hemor-
cases of prehospital interventions performed on MWDs in the rhage control, burn management, airway management, chest
combat setting. This study found that common interventions procedure, bandage, and wound care.
2
performed included trauma dressings (33% of interventions
performed), chest seals (13%), and analgesics (13%). Addi- Database Description
tionally, the majority of injured MWDs in this study incurred Data were obtained from the TRAC2ES (https://trac2es
injuries to the extremities. Collectively, research on injury and .transport.mil/) for CENTCOM, an electronic platform that
intervention patterns for MWDs is sparse compared to human coordinates medical transport of all Department of Defense
combatants. (DoD) patients worldwide. When a regulated, military, medi-
9
cal transport is made, and entry is recorded in TRAC2ES. Data
Goal of this Study entered in TRAC2ES includes patient demographics, primary
We sought to contribute to the limited data available with diagnosis, origin, destination, and evacuation priority level.
data specific to MWDs within the Transportation Command There is also an ability to free text a patient’s history, which
Regulating and Command & Control Evacuation System can be used to provide relevant information about the patient’s
(TRAC2ES). clinical course. Data were abstracted from the free text within
TRAC2ES (SAJ, CEC) with 10% used for verification.
Methods
Data Analysis
Ethics We performed all statistical analysis using Excel (Microsoft,
The US Air Force 59 Medical Wing regulatory office re- https://www.microsoft.com/en-us/microsoft-365/excel). Data
th
viewed protocol FWH20180147E and determined it was ex- were reported in frequencies and percentages. Percentages
empt from Institutional Review Board oversight. Only data were calculated based on the number of occurrences over the
de-identified was obtained for use in this study. total occurrences per category (cause of injury, type of injury,
intervention, outcome).
Subjects and Setting
We conducted a retrospective review of prospective entries
of patient care into TRAC2ES in the U.S. Central Command Results
(CENTCOM) theater of operations from 1 January 2008 to From January 2008 to November 2018, out of the 95 MWD
27 November 2018. TRAC2ES is a database used for tracking entries within our dataset from CENTCOM, 11 were found
all regulated medical transport. While mainly used to track to be duplicate entries, leaving 84 individual MWD encoun-
human movement, there were several entries of transported ters for analysis. While there is likely a much larger number
MWDs. Each new leg of transport for a patient corresponded of MWD injuries, only these 84 were transported within
to a new entry in the TRAC2ES database. We included all TRAC2ES. As such, these 84 were the only ones analyzed
MWD patients that were tracked for transport by TRAC2ES in this study. Overall, there were no documented deaths or
during this timeframe. The database was searched for “dog,” documented euthanasia. However, six nontraumas stated the
“MWD,” “vet,” “veterinarian,” and “canine.” The history MWD was not likely to return to duty (RTD). Nine traumas
was reviewed to determine if the patient was an MWD. If an stated the MWD was unlikely to RTD. The were no encoun-
entry was repeated with additional information later during a ters that explicitly stated the MWD was likely to RTD.
second transportation log, relevant information was extracted
from both entries to create an encounter which included all Thirty-six (47%) of the MWDs were traumas. The most com-
entries for which one MWD was transported for a medical mon cause of injury for trauma was GSW (31%) (Table 1).
reason. All entries that fit our criteria were included in the The majority of trauma MWDs incurred an injury to the ex-
study. Entries were manually reviewed by a study team mem- tremities (67%) (Table 2). Twenty-five percent of traumas re-
ber and the data were extracted into an Excel database. We sulted in hemorrhage requiring intervention. The majority of
verified 10% of the cases for interrater accuracy. Additionally, these MWDs recorded receiving an analgesic (67%) including
if an encounter was not easily categorized, the primary inves- carprofen, tramadol, fentanyl, lidocaine, and hydromorphone
tigators (SAJ, CEC, SGS) would discuss to determine which (Table 3). While we were able to abstract some of the analge-
category fit best. sics utilized, the type of pain medication was often unspeci-
fied. Sedatives were recorded in 25% of traumas. Sedatives
Data were extracted from the free text entries in TRAC2ES included morphine, ketamine, dexmedetomidine, midazolam,
to determine cause of injury, type of injury, interventions per- acepromazine, and medetomidine.
formed, and disposition of the MWDs. For those with trau-
matic injuries, we classified cause of injuries into gunshot TABLE 1 Cause of Trauma Injuries
wounds, explosions, fall, unspecified and other. The resultant Traumatically Injured MWDs,
injuries were then categorized into hemorrhage, airway injury, Cause of Injury No. % (N = 36)
thorax injury (e.g., lung trauma, pneumothorax, etc.), abdom- Gunshot wound 31 (11)
inal trauma (e.g., solid organ, hollow viscus, etc.), extremity
injury, dental injury, facial injury, and other. We classified non- Explosion 22 (8)
trauma/other medical issues into gastrointestinal, hematologic/ Fall 14 (5)
oncologic, abscess/infection, behavioral, nontraumatic ortho- Unspecified 19 (7)
pedic, cardiac, neurologic, genitourinary, dental, environmen- Other 14 (5)
tal, ingestion/toxicologic, spinal, and other. All interventions MWD = military working dog.

98 | JSOM Volume 22, Edition 1 / Sping 2022