The epidemiology of Critical Care Air Transport Team operations in contemporary warfare.

Critical Care Air Transport Teams (CCATTs) have evolved as a vital component of the U.S. Air Force's aeromedical evacuation system. Previous epidemiological research in this area is limited. The objective of this commentary is to highlight the importance of obtaining robust epidemiological data regarding patients transported by CCATTs. A limited epidemiological analysis was performed to describe CCATT patients transported during Operation Enduring Freedom and the waning months of Operation Iraqi Freedom. CCATT transports for the calendar year 2011 were examined as recorded in the U.S. Transportation Command Regulating and Command and Control (C2) Evacuation System database. As many as 290 CCATT primary patient transport records were reviewed. Of these, 58.6% of patients had multiple injuries, 15.9% of patients had traumatic brain injury, 7% had acute coronary syndromes, and 24.8% of all transports were for nonbattle-related injuries. The most common International Classification of Disease, 9th Edition, Clinical Modification coded injury was bilateral lower extremity amputation (40%). Explosive blasts were the top mechanism of injury for patients requiring CCAT. The distribution of injuries and illnesses requiring CCAT appear to have changed compared to previous conventional conflicts. Understanding the epidemiology of casualties evacuated by CCATT during modern warfare is a prerequisite for the development of effective predeployment training to ensure optimal outcomes for critically ill and injured warriors.