Analysis of Life-Saving Interventions Performed by Out-of-Hospital Combat Medical Personnel

Abstract

Background: To analyze casualties from the Camp Eagle Study, focusing on life-saving interventions (LSI) and potentially survivable deaths. Methods: Retrospective cohort of battle casualties from a forward base engaged in urban combat in Central Iraq. Medical support included emergency medicine practitioners and combat medics with advanced training and protocols. LSI were defined as advanced airway, needle or tube thoracostomy, tourniquet, and hypotensive resuscitation with Hetastarch. Cases were assessed retrospectively for notional application of a Remote Damage Control Resuscitation protocol using blood products. Results: Three hundred eighteen subjects were included. The case fatality rate was 7%. Urgent (55) or priority (88) medical evacuation was required for 45% of casualties. Sixty-one LSI were performed, in most cases by the physician or PA, with 80% on urgent and 9% on priority casualties, respectively. Among survivors requiring LSI, the percentage actually performed were airway 100%; thoracostomy 100%; tourniquet 100%; hetastarch 100%. Among nonsurvivors, these percentages were 78%, 50%, 100%, and 56%, respectively. Proximate causes of potentially survivable death were delays in airway placement and ventilation (40%), no thoracostomy (20%), and delayed evacuation resulting in hemorrhagic shock (60%). The notional Remote Damage Control Resuscitation protocol would have been appropriate in 15% of urgent survivors and in 26% of nonsurvivors. Conclusion: LSI were required by most urgent casualties, and a lack or delay in their performance was associated with increased mortality. Forward deployment of blood components may represent the next addition to LSI if logistical and scope-of-practice issues can be overcome. Key Words: Military medicine, War, Emergency medical services, Remote damage control resuscitation, trauma resuscitation.

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Document Details

Document Type
Technical Report
Publication Date
Jul 01, 2011
Accession Number
ADA615265

Entities

People

  • Johnathon A. Berry
  • Lorne H Blackbourne
  • Robert T. Gerhardt

Organizations

  • United States Army Institute of Surgical Research

Tags

Communities of Interest

  • Biomedical

DTIC Thesaurus Topics

  • Analgesia
  • Brain Injuries
  • Casualties
  • Combat Casualty Care
  • Combat Injuries
  • Health Services
  • Hospitals
  • Medical Evacuation
  • Medical Personnel
  • Military Medicine
  • Patient Care
  • Surgery
  • Therapy
  • Warfare

Fields of Study

  • Medicine

Readers

  • Medical or Health Care Field.
  • Personnel Management and Statistics in the Military and Department of Defense
  • Trauma Surgery or Emergency Medicine.