Died of Wounds on the Battlefield: Causation and Implications for Improving Combat Casualty Care

Background Understanding the epidemiology of death after battlefield injury is vital to combat casualty care performance improvement. The current analysis was undertaken to develop a comprehensive perspective of deaths that occurred after casualties reached a medical treatment facility. Methods Battle injury died of wounds DOW deaths that occurred after casualties reached a medical treatment facility from October 2001 to June 2009 were evaluated by reviewing autopsy and other postmortem records at the Office of the Armed Forces Medical Examiners OAFME. A panel of military trauma experts classified the injuries as nonsurvivable NS or potentially survivable PS, in consultation with an OAFME forensic pathologist. Data including demographics, mechanism of injury, physiologic and laboratory variables, and cause of death were obtained from the Joint Theater Trauma Registry and the OAFME Mortality Trauma Registry. Results DOW casualties n 58 accounted for 4.56 of the nonreturn to duty battle injuries over the study period. DOW casualties were classified as NS in 271 48.6 cases and PS in 287 51.4 cases. Traumatic brain injury was the predominant injury leading to death in 225 of 271 83 NS cases, whereas hemorrhage from major trauma was the predominant mechanism of death in 230 of 287 80 PS cases. In the hemorrhage mechanism PS cases, the major body region bleeding focus accounting for mortality were torso 48, extremity 31, and junctional neck, axilla, and groin 21. Fifty-one percent of DOW casualties presented in extremis with cardiopulmonary resuscitation upon presentation. Conclusions Hemorrhage is a major mechanism of death in PS combat injuries, underscoring the necessity for initiatives to mitigate bleeding, particularly in the prehospital environment.