Page 62 - JSOM Fall 2022

a cervical spinal injury, the Joint Trauma System clinical prac­ study design, we can draw conclusions describing only the in­
tice guidelines support collar use because of suspected injury cidence of helicopter crash injuries and interventions, so cor­
26
patterns with deceleration forces. Of case reports document­ relations are limited.
ing injury patterns among helicopter crash patients, only one
cervical fracture was identified, an unstable odontoid fracture.
Most vertebral injuries are of the lower thoracic and upper Conclusion
lumbar vertebrae. 8,9,24­26 For military providers responding to Unlike ground combat operations, where the extremities are
helicopter crash incidents, cervical collars and backboards are most frequently injured, the thorax was at highest risk within
useful equipment, permitted space is available, although air­ our data set. Survival was high for service members who
way and hemodynamic equipment should take precedent. reached medical care with surgical capabilities after helicop­
ter crashes. To optimize planning and future outcomes, better
Tourniquets were placed on approximately half the patients data capture systems are needed to study both prehospital in­
with extremity injuries. Tourniquets are frequently placed pre­ terventions and the deaths that occur prehospital of those who
emptively to control for potential massive hemorrhage because do not reach military treatment facilities providing surgical
extremity hemorrhage is the primary cause of preventable com­ care. The high proportion of nonbattle injuries highlights the
27
bat death on the battlefield. However, only two patients re­ risks associated with helicopters in general.
ceived blood prehospital, and none received tranexamic acid,
so either tourniquets effectively controlled massive hemorrhage Acknowledgments
in casualties, thereby limiting the use of resuscitation products, We would like to thank the Joint Trauma System Data Analy­
or there was minimal life­threatening hemorrhage. The latter sis Branch for their efforts with data acquisition.
would be consistent with previous studies and case reports of
helicopter crashes, demonstrating that life­ threatening hem­ Author Contributions
orrhage is a rare finding in survivable crashes. 7–9,17,24,25 Typi­ JWJ and AMS conceived the study concept and wrote the first
cally, shear forces rather than penetrating injuries are produced draft. SGS coordinated and analyzed the data. HMH, WW,
through the deceleration forces and would not have ongoing CC, and GJH revised, edited, and provided practical experi­
treatable hemorrhage during first responder transport. These ence. All authors read and approved the final manuscript.
tend to be rapidly fatal because of aortic root tears or pelvic
fractures, as described in prior studies, 7,17,28 unless the surgical Disclosure of Financial Interest
None.
capabilities are brought to the patient at the point of injury, as
demonstrated in a patient described by Miller et al. 8
Funding
This research did not receive any specific grant from funding
Study Limitations agencies in the public, commercial, or not­for­profit sectors.
There are several limitations to this study. First, the DODTR
does not include data from fatalities or unrecoverable crashes, Disclaimer
leading to possible selection bias. In other words, those who The views expressed herein are those of the authors and do not
died prior to reaching a facility with surgical capabilities will reflect the official policy or position of the Department of the
not be captured, which creates a survival bias within the regis­ Army, Department of Defense, or the U.S. Government.
try. Therefore, there is a high probability that numerous casu­
alties did not reach surgical capabilities, and thus our data set Data Availability Statement
misrepresents the survivability of military helicopter crashes. The data that support the findings of this study are available
Although some of the helicopter crashes that produced fatal­ from the Joint Trauma System (JTS) DODTR. Restrictions ap­
ities may have been initially survivable with point­of­injury ply to the availability of these data, which were used under a
care, we are unable to conclude which interventions respond­ data sharing agreement for this study.
ers should prepare for without a description of these injuries.
This represents a major gap in data, for which the military References
currently has no unclassified performance­improvement solu­ 1. Polmar N, Kennedy FD Jr. Military Helicopters of the World. An­
tion. On the opposite end of the spectrum, those with minor napolis, MD: Naval Institute Press; 1981.
injuries who were fully treated close to the point of injury and 2. National Transportation Safety Board. Aviation Accident Data-
returned to duty without reaching a Role 2 with surgical capa­ base and Synopses. 1963–2019. https://www.ntsb.gov/_layouts/
ntsb.aviation/Index.aspx. Accessed 1 October 2020.
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to improved survivability. J Am Helicopter Soc. 2018;63(2):1–25.
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DODTR, with improved documentation of prehospital care vival enhancements: an evaluation of the costs, benefits and effec­
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one of the largest barriers to this integration. Both factors lim­ rates. Mil Med. 1999;164(2):116–118.
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