Page 59 - JSOM Fall 2022

Helicopter Crashes in the Deployed Combat Setting

The Department of Defense Trauma Registry Experience

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Joseph W. Jude, MD, MC *; Adam M. Spanier, MD, MC ;
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Hugh M. Hiller, MD, MC ; Wells Weymouth, MD, MC ;
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Cord Cunningham, MD, MC ; Guyon J. Hill, MD, MC ; Steven G. Schauer, DO, MC 7

ABSTRACT
Background: Military helicopter mishaps frequently lead to have crashes, from 4 total crashes in 1963 to 130 in 2019.
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multiple casualty events with complex injury patterns. Data Fortunately, aircraft safety measures have kept pace, leading
specific to this mechanism of injury in the deployed setting are to a higher proportion of survivable injuries. In addition,
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limited. We describe injury patterns associated with helicopter mishap rates are decreasing; in fiscal year 2007, the US Army
crashes. Materials and Methods: This is a secondary analysis of had its lowest Class A flight mishap rate (defined by property
a Department of Defense Trauma Registry (DODTR) dataset damage cost and presence of fatality or permanent total dis­
from 2007 to 2020 seeking to describe prehospital care within ability) in 35 years, at 2.39 mishaps per 100,000 flying hours.
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all theaters in the registry. We searched within the dataset for Ultimately, although these safety trends are promising, crashes
casualties injured by helicopter crash. A serious injury was de­ and injuries still happen. Understanding the injury mechanism
fined by an abbreviated injury scale of ≥3 by body region. Re- patterns would increase the ability of both first responders and
sults: We identified 120 casualties injured by helicopter crash physicians to care for these patients.
within the dataset. Most were Army (64%), the median age
was 30 (interquartile range [IQR] 26–35), and most were male Research focusing on helicopter crash injury patterns in the
(98%), enlisted service members made up the largest cohort military has had significant strategic importance dating back
(47%), with most injuries occurring during Operation Endur­ to the Vietnam conflict. Five of eight total General Officer
ing Freedom (69%). Only 2 were classified as battle injuries. deaths in Vietnam occurred in helicopter crashes. Early data
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The median injury severity score was 9 (IQR 4–22). Serious from the initial phases of Operation Enduring Freedom (OEF)
injuries by body region are the following: thorax (27%), head/ and Operation Iraqi Freedom (OIF) show a notable reduction
neck (17%), extremities (17%), abdomen (11%), facial (3%), in the rate of loss of aircraft and fatalities but do not explore
and skin/superficial (1%). The most common prehospital in­ the injuries found in these crashes. Although military avia­
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terventions focused on hypothermia prevention/management tion equipment and airframes differ from their civilian coun­
(62%) and cervical spine stabilization (32%). Most patients terparts, time spans with fewer combat operations have had
survived to hospital discharge (98%). Conclusions: Serious in­ similar mishap rates compared with civilian data. 6
juries to the thorax were most common. Survival was high, al­
though better data capture systems are needed to study deaths With regard to specific injury patterns, Shanahan et al. found
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that occur prehospital that do not reach military treatment fa­ that head and extremity injuries were the most frequent body re­
cilities with surgical care to optimize planning and outcomes. gions affected in survivable crashes, but their 1979–1985 anal­
The high proportion of nonbattle injuries highlights the risks ysis predates current combat operations and airframes. Combat
associated with helicopters in general. flight plans carry more risk because of frequent night flights and
enemy engagements. Current data on combat injury patterns
Keywords: helicopter crash; rotary wing mishap; mass casualty; are isolated to case reports of multiple casualty events. Over­
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traumatic resuscitation; military medicine all, more data from private civilian, emergency medical services
or other public service agencies, and military helicopter crash
injury patterns would better prepare prehospital and hospital
providers alike to stabilize and resuscitate critically ill patients.
Introduction
Background Goal of This Investigation
Rotary wing air transportation is widely used in the civilian, We sought to describe the prehospital interventions and out­
public service, and military sectors. However, as the popular­ comes through discharge from the hospital associated with he­
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ity of helicopter usage in the United States has increased, so licopter crashes in the deployed, combat setting.
Previously accepted for poster presentation at the 2021 Special Operations Medical Association Scientific Assembly, Charlotte, NC.
*Correspondence to joseph.w.jude.mil@mail.mil
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1 CPT Joseph W. Jude and CPT Adam M. Spanier are affiliated with the Carl R. Darnall Army Medical Center, Fort Hood, TX. CPT Hugh M.
Hiller is affiliated with the Womack Army Medical Center, Fort Bragg, NC. CPT Wellis Weymouth is affiliated with Hunter Army Airfield, Fort
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Stewart, GA. COL Cord Cunningham is affiliated with the Carl R. Darnall Army Medical Center, Fort Hood, and with Uniformed Services Uni­
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versity of the Health Sciences, Bethesda, MD. LTC(P) Guyon J. Hill is affiliated with the Carl R. Darnall Army Medical Center, Fort Hood, and
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Dell Children’s Medical Center, Austin, TX. MAJ Steven G. Schauer is affiliated with Brooke Army Medical Center, JBSA Fort Sam Houston,
TX, the US Army Institute of Surgical Research, JBSA Fort Sam Houston, and Uniformed Services University of the Health Sciences, Bethesda.
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