En-Route Care Capability from Point of Injury Impacts Mortality after Severe Wartime Injury
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
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.
- Medicine and Medical Research
- Weapons Effects (Biological)
- Escape, Rescue and Survival