Prehospital Interventions Performed in a Combat Zone: A Prospective Multicenter Study of 1,003 Combat Wounded
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Battlefield care given to a casualty before hospital arrival impacts clinical outcomes. To date, the published data regarding care given in the prehospital setting of a combat zone are limited. The purpose of this study was to describe the incidence and efficacy of specific prehospital lifesaving interventions LSIs interventions that could affect the outcome of the casualty, consistent with the Tactical Combat Casualty Care paradigm, performed during the resuscitation of casualties in a combat zone. METHODS We performed a prospective observational study between November 2009 and November 2011. Casualties were enrolled as they were treated at six US surgical facilities in Afghanistan. Descriptive data were collected on a standardized data collection form and included mechanism of injury, airway management, chest and hemorrhage interventions, vascular access, type of fluid administered, and hypothermia prevention. On arrival to the military hospital, the treating physician determined whether an intervention was performed correctly and whether an intervention was not performed that should have been performed missed LSI. RESULTS A total of 1,003 patients met the inclusion criteria. Their mean SD age was 25 8.5 years and 97were male. The mechanism of injury was explosion in 60 of patients, penetrating in 24 of patients, blunt in 15 of patients, and burn in 0.8 of patients. The most commonly performed LSIs included hemorrhage control n 599, hypothermia prevention n 429, and vascular access n 388. Of the missed LSIs, 252 were identified with the highest percentage of missed opportunities being composed of endotracheal intubation, chest needle decompression, and hypotensive resuscitation. In contrast, tourniquet application had the lowest percentage of missed opportunities.
- Medicine and Medical Research
- Military Forces and Organizations