![]() 8–10 Modern combat casualty care has evolved from investigation of casualty data from prior conflicts, and recently, a subset of deaths from Iraq and Afghanistan. 7 Analysis of civilian trauma deaths has been essential to the development of trauma systems, and assessing their performance over time. To improve treatment, identify the equipment needs and develop training for military medical personnel in a combat theater, patterns of current combat deaths should be analyzed to direct health care interventions and research. 5 In total, the DOD has issued 11 policies or clinical practice guidelines for combat care based on the ongoing analysis of the conflicts. 1 Additionally, ongoing collaborative efforts between the military and civilian level I trauma centers provide hands on training for deploying units. Such courses include the Tactical Combat Casualty Care, Emergency War Surgery, and the Joint Forces Combat Trauma Management Course. A number of predeployment training courses have been developed for medical personnel to hone their skills in trauma and critical care before deployment. 4 In addition, weekly tri-continent trauma rounds are conducted to counteract the inevitable disconnect that occurs as wounded soldiers are rapidly moved to Germany and then the United States via the air evacuation chain. 1 Examples of this include advancements in point of injury care, such as, fielding of the Combat Application Tourniquet, 2,3 and hemostatic dressings. As opportunities to improve the outcome of wounded soldiers are identified, changes are implemented through the Joint Theater Trauma System. To counteract this, there is an ongoing effort to improve battlefield care through training, evidence-based clinical guidelines, and research. The insurgency war has intensified with increased sophistication and use of improvised explosive devices (IED). Presumably, this would be a result of the change in enemy tactics. There is a common opinion among military medical personnel returning from a second or third deployment to Iraq or Afghanistan that war wounds have increased in severity. ![]() Arguably, the success of the medical improvements during this war has served to maintain the lowest case fatality rate on record. Truncal hemorrhage is the leading cause of potentially survivable deaths. In the time periods of the war studied, deaths per month has doubled, with increases in both injury severity and number of wounds per casualty. 71), whereas the case fatality rates between the two time periods were equivalent (11.0 vs. Deaths per month between groups doubled (35 vs. The main cause of death in the PS fatalities was truncal hemorrhage (51% vs. 37 ± 16, p < 0.001), and had a lower number of abbreviated injury scores ≥4 (1.1 ± 0.79 vs. Of the PS fatalities (group 1: 93 and group 2: 139), the injury severity score was lower in the first group (27 ± 14 vs. There were 486 cases from March 2003 to April 2004 (group 1) and 496 from June 2006 to December 2006 (group 2) that met inclusion criteria. PS deaths were then reviewed in depth to analyze mechanism and cause. Fatalities were classified as nonsurvivable (NS) or potentially survivable (PS). Methods:Īutopsies of the earliest combat deaths from Iraq and Afghanistan and the latest deaths of 2006 were analyzed to assess changes in injury severity and causes of death. Furthermore, we examined cause of death looking for opportunities of improvement for research and training. We hypothesized that the severity of wounds has increased over time. To continuously improve combat casualty care, the Department of Defense has enacted numerous evidence-based policies and clinical practice guidelines. The opinion that injuries sustained in Iraq and Afghanistan have increased in severity is widely held by clinicians who have deployed multiple times.
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