En-route care capability from point of injury impacts mortality after severe wartime injury

Ann Surg. 2013 Feb;257(2):330-4. doi: 10.1097/SLA.0b013e31827eefcf.

Abstract

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 en-route 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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Afghan Campaign 2001-
  • Brain Injuries / mortality
  • Brain Injuries / therapy
  • Female
  • Hospital Mortality
  • Humans
  • Injury Severity Score
  • Male
  • Military Medicine / methods*
  • Military Personnel*
  • Patient Transfer / methods*
  • Thoracic Injuries / mortality
  • Thoracic Injuries / therapy
  • United Kingdom
  • United States
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / therapy*
  • Young Adult