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To compare statistics involving interventions performed on This indicates that there were several other injuries that were
traumas, Reeves et al. assessed interventions in the prehospital left out of the histories in addition to hemorrhage.
setting performed on 11 MWDs, nine of which sustained GSWs
and three of which experienced blasts, which reflects more The nature of the TRAC2ES data repository has several lim-
trauma than our dataset. Only two chest procedures were per- itations. First, TRAC2ES only tracks regulated evacuations of
2
formed in our dataset, while four were performed in their much patients. Therefore, patients that did not survive to transport
smaller dataset. Forty-five percent of interventions performed in were not captured. Second, TRAC2ES only records regulated
Reeves et al.’s study was for hemorrhage control, while only 7 transports on a medical platform. It does not capture patients
of 104 interventions preformed for trauma in our dataset (7%) moved by nonstandardized casualty evacuation (CASEVAC)
were for hemorrhage. This may, again, be explained by survival platforms. In addition, the data recorded is limited and based
bias. Finally, 67% of the traumas in our dataset recorded some on the free text entries which contain varying levels of detail,
type of analgesia, while only 18% of MWDs in their report re- as well as are at the discretion of the treating medical person-
ceived pain medications. The differences in interventions likely nel. This limits the information available, and we are unable
stem from the fact that their data were performed in the prehos- to assess data that was omitted from the history. Roles of care
pital setting. Thirty-one percent of the traumas in our dataset were not consistently recorded in the database, so this could
recorded undergoing surgery, indicating that they were likely not be analyzed. Moreover, some of the entries may have been
in a military treatment facility already and needed to be trans- entered by nonmedical personnel which may account for the
ferred to a veterinary-capable facility. This means that many of variances in details relevant to medical care.
the prehospital interventions typically performed (hemorrhage
dressings, chest seal, etc.) were not used. Furthermore, 50% of Conclusion
the MWDs in Reeves et al.’s study did not survive, while all
MWDs in our dataset survived long enough to begin transport Of the MWDs in our dataset, most were transported for non-
for an encounter to be generated in TRAC2ES. trauma. The most frequent intervention was medication ad-
ministration for both traumatic and nontraumatic injuries.
There are no published reports discussing interventions per- Our dataset adds to the limited body of MWD encounters in
formed on non–traumatically-injured MWDs. Overall, our theater.
dataset differs greatly from previously published research, pre-
sumably due to the differences in circumstances of where the Acknowledgments
data comes from – a transportation-specific data repository. We would like to thank Mr Mark Barnes from TRANSCOM
This report is the first of its kind in its examination of causes for providing us with these data.
of injury, injury patterns, and interventions performed on a
large dataset of MWDs who survived their injuries. To this Authorship Statement
end, the development of an MWD-specific performance im- SJ and CC analyzed the data. SJ and CC wrote the first draft
provement system like the DoDTrauma Registry would greatly of the manuscript with help from SS. LR and KB offered their
improve the science of MWD care in theater. expertise on the subject and guided data analysis. SS is the
principal investigator for the overall study from which these
There are some oddities found in this research that require data were derived. All authors edited the manuscript, read,
further investigation. Sixty-seven percent of traumatic injuries and approved the final manuscript.
were to the extremities, which indicates a need for improved
protection for MWDs. Current body protection equipment is Conflicts of Interest
thick and may result in overheating in MWDs, so further re- We have no conflicts to report.
search is required to develop lighter protective equipment that
offers additional coverage of the limbs. A complicating factor Disclaimer
2
in the development of protective equipment for MWDs are the The views expressed in this article are those of the authors and
mechanics of the canine body. do not reflect the official policy or position of the US Army
Medical Department, Department of the Army, Department of
Major differences between the anatomy of MWDs as com- Defense, or the US Government.
pared to humans lead to different types of injury patterns. Ad-
ditionally, the cause of injuries differs greatly between MWDs Funding
and their human counterparts. This may be a simple reflection This research was supported in part by an appointment to
of the anatomical differences, or the result of the risk of ex- the Student Research Participation Program at the US Army
posure due to the varied missions (e.g., patrol versus direct Institute of Surgical Research administered by the Oak Ridge
action). Furthermore, much of the data on injured MWDs is Institute for Science and Education through an interagency
undocumented, as highlighted by the fact that 19% of trau- agreement between the US Department of Energy and USAISR.
matic causes of injuries were not captured. Additionally, al- We received no funding for this effort.
though there were 87 reports of medication administration,
this number is likely much higher. Several MWDs who under- References
went surgery had no medications listed, but it can be assumed 1. Miller L, Pacheco GJ, Janak JC, et al. Causes of death in mili-
that these MWDs were under sedation minimally. Seeing as tary working dogs during Operation Iraqi Freedom and Opera-
not all medications were listed, it is likely that much more tion Enduring Freedom, 2001–2013. Mil Med. 2018;183(9–10):
e467–e474.
important medical history is left out as well. Additionally, 2. Reeves LK, Mora AG, Field A, Redman TT. Interventions per-
many MWDs sustained GSWs (11 MWDs) or blasts (9) as formed on multipurpose military working dogs in the prehospital
well as other injuries that would typically result in bleeding, combat setting: A comprehensive case series report. J Spec Oper
but there were only nine recorded occurrences of hemorrhage. Med. 2019;19(3):90–93.

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