Keene Damian Douglas, Penn-Barwell J G, Wood P R, Hunt N, Delaney R, Clasper J, Russell R J, Mahoney P F
Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK.
Institute of Naval Medicine, Gosport, UK.
J R Army Med Corps. 2016 Oct;162(5):355-360. doi: 10.1136/jramc-2015-000490. Epub 2015 Oct 14.
Combat casualty care is a complex system involving multiple clinicians, medical interventions and casualty transfers. Improving the performance of this system requires examination of potential weaknesses. This study reviewed the cause and timing of death of casualties deemed to have died from their injuries after arriving at a medical treatment facility during the recent conflicts in Iraq and Afghanistan, in order to identify potential areas for improving outcomes.
This was a retrospective review of all casualties who reached medical treatment facilities alive, but subsequently died from injuries sustained during combat operations in Afghanistan and Iraq. It included all deaths from start to completion of combat operations. The UK military joint theatre trauma registry was used to identify cases, and further data were collected from clinical notes, postmortem records and coroner's reports.
There were 71 combat-related fatalities who survived to a medical treatment facility; 17 (24%) in Iraq and 54 (76%) in Afghanistan. Thirty eight (54%) died within the first 24 h. Thirty-three (47%) casualties died from isolated head injuries, a further 13 (18%) had unsurvivable head injuries but not in isolation. Haemorrhage following severe lower limb trauma, often in conjunction with abdominal and pelvic injuries, was the cause of a further 15 (21%) deaths.
Severe head injury was the most common cause of death. Irrespective of available medical treatment, none of this group had salvageable injuries. Future emphasis should be placed in preventative strategies to protect the head against battlefield trauma.
战伤救治是一个复杂的系统，涉及多名临床医生、医疗干预措施和伤员转运。提高该系统的效能需要检查潜在的薄弱环节。本研究回顾了在伊拉克和阿富汗近期冲突期间抵达医疗救治机构后因伤死亡的伤员的死亡原因和时间，以确定可能改善救治结果的领域。
这是一项对所有活着抵达医疗救治机构、但随后死于在阿富汗和伊拉克作战行动中所受伤害的伤员的回顾性研究。它涵盖了从作战行动开始到结束期间的所有死亡情况。利用英国军方联合战区创伤登记处来确定病例，并从临床记录、尸检记录和验尸官报告中收集更多数据。
有71名与战斗相关的死亡伤员存活至医疗救治机构；其中17名（24%）在伊拉克，54名（76%）在阿富汗。38名（54%）在最初24小时内死亡。33名（47%）伤员死于孤立性头部损伤，另有13名（18%）有不可救治的头部损伤，但并非孤立性损伤。严重下肢创伤后的出血，通常伴有腹部和骨盆损伤，是另外15名（21%）伤员的死亡原因。
严重头部损伤是最常见的死亡原因。无论现有医疗救治情况如何，这组伤员中无人有可挽救的损伤。未来应将重点放在预防策略上，以保护头部免受战场创伤。
