Page 125 - JSOM Winter 2022

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for optimizing patient outcomes. Furthermore, this MTMR Anatomical location was defined by the site on the MWD
process, which is based on the World Health Organization’s body where the primary injury occurred. Body regions were
and the American College of Surgeons Committee on Trau- selected based on previous canine injury research and further
ma’s concept of trauma-related preventable death, utilizes sub- divided into specific regions of interest. 15,16 Survival status
ject matter expert (SME) review of medical records to define was determined by whether the MWD survived to hospital
a trauma-related death as “preventable,” “potentially prevent- discharge. MWDs that were coded as “died” may have died
able,” or “not preventable” based on the probability of sur- prior to the receipt of medical care or after reaching veterinary
vival, trauma or injury severity score, or any combination of medical care. For each variable, categories with small numbers
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these. The purpose of the MTMR process is to guide research were combined in the other/unknown category. Details of data
analyzing preventable combat mortality for the strategic focus abstraction and classification of key demographic and injury
of tactical medicine, equipment, and training in order to elim- characteristics are described in detail elsewhere. 15
inate preventable death on the battlefield. 7,12 The framework
used to establish this process provides a guide on battlefield MWD injury events were reviewed by a panel of SMEs com-
injury and prevention, tactical and environmental factors to posed of four Army veterinary specialists with deployment
consider, military definitions for preventable death categories, experience and board certification in either emergency/critical
and SME panel composition and review process. The authors care (TE), surgery (JG), internal medicine (SK), or pathology
believe that the same approach that has been used to investi- (BS). The SME panel composition and the review process-
gate trauma-related preventable death in Servicemembers can mirrored that which has been suggested as a standard for
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also be applied to MWDs. determining preventable death in US Servicemembers. Each
member of the SME panel independently reviewed the veter-
Despite this promising approach, neither the concept of trau- inary treatment records in a group setting to determine the
ma-related preventable death nor the MTMR process has injury prevention category. Injury events were categorized as
been used to assess deployment-related traumatic injuries in follows: preventable – defined as an injury that was directly
MWDs. This may be due, in part, to the lack of sufficient or indirectly caused from an error or true accident and could
data captured in veterinary treatment records on diagnostics, have been avoided had appropriate steps been taken; poten-
treatments, and patient outcomes after a traumatic event com- tially preventable – defined as an injury suffered by an MWD
pared with human medical records. Without detailed medical that could have been prevented if they had every option of
records, animal autopsy reports, injury severity scores (such as protective equipment that is available today for dogs (such as
the Animal Trauma Triage score), death preventability cannot booties for feet protection, bulletproof vests, eye protection,
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be determined. However, many veterinary treatment records and ear protection) and/or the most highly trained and expe-
still contain extensive information on how the injury occurred rienced handler with extensive knowledge in canine handling
for many traumatic events, making it possible to infer the pre- in combat zones; and unpreventable – defined as direct inju-
ventability of the reported injury-inducing event. ries that would have still occurred even with a highly skilled
handler and every option of protective equipment (e.g., direct
The current case-series study applied the preventable death explosion or blast). SME panel members could also select the
review process to identify gaps in injury prevention by eval- category of not enough information if they felt there were not
uating injury events and determining if the injury was pre- enough details in the veterinary treatment record to classify the
ventable, potentially preventable, or unpreventable among injury as preventable, potentially preventable, or unprevent-
MWDs deployed to the Central Command (CENTCOM) able. Categorization of each injury was determined based on
area of responsibility (AOR). Potential interventions were also panel consensus. If an evenly split decision was reached, a fifth
identified for injury events determined to be preventable or Army veterinarian (JC) evaluated the record and decided the
potentially preventable. Lastly, because multipurpose canines injury prevention category. Finally, two additional categories
(MPCs) are unique MWDs assigned to US Special Operations were created: (1) preventable/potentially preventable injuries –
Forces (SOF) units and are known to encounter higher risk of defined as an injury that was considered either preventable
injury and death than conventional MWDs, injury event char- or potentially preventable and (2) preventable/potentially pre-
acteristics were compared between conventional MWDs and ventable injuries that lead to death – defined as death from an
MPCs to determine if there were any meaningful differences injury that was considered either preventable or potentially
by certification/unit assignment. 15 preventable.

If the SME panel determined that an injury event could have
Methods
been potentially prevented, it then selected a primary inter-
Data from a previous study on MWD trauma were collected vention that may have helped to prevent or mitigate the in-
under an exempt protocol from the Department of Defense jury. The intervention categories were as follows: improved
Military Working Dog Veterinary Service Institutional An- handler training, improved canine protective equipment, and
imal Care and Use Committee. The authors of that study a change in policy or doctrine. Not applicable interventions
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extracted information on traumatic injuries from official US are for those that were not considered preventable/potentially
military veterinary treatment records for MWDs who were preventable injuries.
injured while deployed to the CENTCOM AOR from 11 Sep-
tember 2001 to 31 December 2018. The original study iden- Because injury risk has been shown to differ between MPCs
tified 165 injured MWDs, some of whom experienced more and conventional MWDs, injury event characteristics were
than one injury at different times. In the current study, these compared between these two populations of MWDs. For
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additional injuries were considered independent of any prior this secondary analysis, only 190 MWD injury events were
injury, so there were 30 additional injuries for a total of 195 included, as five veterinary treatment records lacked informa-
MWD injury events. tion on certification and unit assignment.

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