From the Defense Health Agency (R.S.K., E.L.M., J.T.H., J.C.J., H.R.M., F.K.B., J.M.G., S.A.S.), Joint Trauma System, Joint Base San Antonio-Fort Sam Houston, Texas; Military and Emergency Medicine (R.S.K., F.K.B.), Department of Pathology (E.L.M.), Department of Radiology (H.T.H.), Department of Surgery (J.M.G., S.A.S.), Uniformed Services University, Bethesda, Maryland; College of Medicine (R.S.K.), Texas A&M University, College Station, Texas; Defense Health Agency (E.L.M., H.T.H.), Armed Forces Medical Examiner System, Dover Air Force Base, Delaware; United States Army Institute of Surgical Research (J.M.G.), Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.B.H.), University of Alabama, Birmingham, Alabama; Department of Public Health (J.T.H.), Department of Surgery (B.J.E.), University of Texas, San Antonio, Texas.
J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S213-S224. doi: 10.1097/TA.0000000000002699.
Death from injury occurs predominantly in prehospital settings. Injury prevention and prehospital care of military forces is the responsibility of combatant commanders. Medical examiner and trauma systems should routinely study fatalities and inform commanders of mortality trends.
Data reported on US Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001, to September 10, 2018, were reevaluated to compare subcommands, units, and trends. Injury was assessed by mechanism, severity, operational posture, and survivability. Death was assessed by manner, cause, classification, mechanism, and preventability.
Of 614 USSOCOM fatalities (median age, 30 years; male, 98.5%), 67.6% occurred in the Army command, of which 49.2% occurred in the Special Forces command. Battle injury accounted for 60.1% of USSOCOM fatalities. Most battle-injured fatalities in each subcommand had nonsurvivable injuries and nonpreventable deaths. For each subcommand except Marine Corps, fatalities with nonsurvivable injuries sustained injuries primarily while mounted. By subcommand, the primary cause of death for fatalities with nonsurvivable injuries was blast for Army (57.6%), multiple/blunt force for Navy (60.0%), gunshot wound for Air Force (55.6%), and split between blast (50.0%) and gunshot wound (50.0%) for Marine Corps. For each subcommand except Air Force, fatalities with potentially survivable-survivable injuries sustained injuries primarily while dismounted, and the mechanism of death was primarily hemorrhage plus other mechanism or hemorrhage alone. Hemorrhage only mechanism of death was surpassed over time by complex multimechanism death. Potential for injury survivability and death preventability was greatest during early and later years of conflict.
Organizational differences in mortality characteristics and trends were identified from which commanders can refine efforts to prevent and treat injury and improve survival. Fatality analyses inform operational risk matrices and advance casualty prevention and response efforts. Prevention, assessment, and treatment strategies must evolve to reduce death from hemorrhage plus coexisting mechanisms.
Performance Improvement and Epidemiological, level IV.
死亡主要发生在院前环境中。军事部队的伤害预防和院前护理是战斗指挥官的责任。法医和创伤系统应定期研究死亡事件，并将死亡率趋势告知指挥官。
重新评估了 2001 年 9 月 11 日至 2018 年 9 月 10 日期间在美国特种作战司令部（USSOCOM）执行任务时死亡的 USSOCOM 人员的死亡数据，以比较下属指挥部、单位和趋势。伤害按机制、严重程度、作战态势和生存能力进行评估。死亡则按方式、原因、分类、机制和可预防性进行评估。
在 614 名 USSOCOM 死亡人员中（中位数年龄为 30 岁；男性占 98.5%），67.6%发生在陆军司令部，其中 49.2%发生在特种部队司令部。战斗伤占 USSOCOM 死亡人数的 60.1%。每个下属指挥部中，大多数战斗受伤死亡人员的受伤无法生存，死亡无法预防。除了海军陆战队，每个下属指挥部中，无法生存的受伤人员主要是在骑乘时受伤。按下属指挥部划分，无法生存的受伤人员的主要死亡原因为陆军的爆炸伤（57.6%）、海军的多发/钝力伤（60.0%）、空军的枪伤（55.6%）以及海军陆战队的爆炸伤（50.0%）和枪伤（50.0%）。除了空军，每个下属指挥部中，有潜在生存能力的可生存受伤人员主要是在下车时受伤，死亡机制主要是出血加其他机制或仅出血。随着时间的推移，单纯出血的死亡机制逐渐被复杂多机制死亡所取代。在冲突的早期和后期，受伤生存能力和死亡预防能力的潜力最大。
从这些死亡率特征和趋势的组织差异中，指挥官可以改进预防和治疗伤害以及提高生存能力的工作。伤亡分析为作战风险矩阵提供信息，并推进伤员预防和应对工作。预防、评估和治疗策略必须不断发展，以减少因出血加共存机制而导致的死亡。
改进绩效和流行病学，四级。
