En-Route Care Capability from Point of Injury Impacts Mortality after Severe Wartime Injury

Abstract

Objective: The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability. Background: Following a decade of war in Afghanistan, the impact of enroute care capabilities from the POI on mortality is unknown. Methods: Casualties evacuated from POI to one level III facility in Afghanistan (July 2008 March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins. Results: Most casualties (n = 1054; 61.2%) were in the low-ISS (1 15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16 50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51 75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 77 vs 113 122; P = 0.013) but there was no difference in mortality. Conclusions: This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.

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Document Details

Document Type
Technical Report
Publication Date
Feb 01, 2013
Accession Number
ADA614771

Entities

People

  • David J. O Reilly
  • John Oh
  • Jonathan Morrison
  • Joseph J. Dubose
  • Lorne H Blackbourne
  • Mark J. Midwinter
  • Robert J. Russell
  • Todd E Rasmussen

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Body Regions
  • Brain Injuries
  • Combat Casualty Care
  • Health Services
  • Hospitals
  • Medical Evacuation
  • Medical Personnel
  • Military Personnel
  • Nato
  • Surgery

Fields of Study

  • Medicine

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