Analysis of Life-Saving Interventions Performed by Out-of-Hospital Combat Medical Personnel
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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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.
- Medicine and Medical Research
- Military Forces and Organizations