Received January 17, 2021 from U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas (SGS, RH, KM, JB); Uniformed Services University of the Health Sciences, Bethesda, Maryland (SGS, MDA, TEB); Brooke Army Medical Center, JBSA Fort Sam Houston, Texas (SGS, TEB); Madigan Army Medical Center, Joint Base Lewis McChord, Washington (JFN); Texas A&M University, College Station, Texas (ADF); Texas National Guard, Arlington, Texas (ADF); 40th Forward Resuscitation and Surgical Detachment, 627 Hospital Center, 1st Medical Brigade, Fort Carson, Colorado (MDA); University of Colorado, Denver, Denver, Colorado (VSB). Revision received March 16, 2021; accepted for publication March 19, 2021.
Prehosp Emerg Care. 2022 May-Jun;26(3):370-379. doi: 10.1080/10903127.2021.1907491. Epub 2021 Apr 16.
Most potentially preventable deaths occur in the prehospital setting before reaching a military treatment facility with surgical capabilities. Thus, optimizing the care we deliver in the prehospital combat setting represents a ripe target for reducing mortality. We sought to analyze prehospital data within the Department of Defense Trauma Registry (DODTR). We requested all encounters with any prehospital activity (e.g., interventions, transportation, vital signs) documented within the DODTR from January 2007 to March 2020 along with all hospital-based data that was available. We excluded from our search casualties that had no prehospital activity documented. There were 28,950 encounters that met inclusion criteria. Of these, 25,897 (89.5%) were adults and 3053 were children (10.5%). There was a steady decline in the number of casualties encountered with the most notable decline occurring in 2014. U.S. military casualties comprised the largest proportion (n = 10,182) of subjects followed by host nation civilians (n = 9637). The median age was 24 years (interquartile range/IQR 21-29). Most were battle injuries (78.6%) and part of Operation ENDURING FREEDOM (61.8%) and Operation IRAQI FREEDOM (24.4%). Most sustained injuries from explosives (52.1%) followed by firearms (28.1%), with serious injury to the extremities (24.9%) occurring most frequently. The median injury severity score was 9 (IQR 4-16) with most surviving to discharge (95.0%). A minority had a documented medic or combat lifesaver (27.9%) in their chain of care, nor did they pass through an aid station (3.0%). Air evacuation predominated (77.9%). Within our dataset, the deployed U.S. military medical system provided prehospital medical care to at least 28,950 combat casualties consisting mostly of U.S. military personnel and host nation civilian care. There was a rapid decline in combat casualty volumes since 2014, however, on a per-encounter basis there was no apparent drop in procedural volume.
大多数可预防的死亡发生在到达有手术能力的军事治疗设施之前的院前环境中。因此，优化我们在院前战斗环境中提供的护理代表了降低死亡率的一个成熟目标。我们试图分析国防部创伤登记处（DODTR）中的院前数据。我们要求从 2007 年 1 月至 2020 年 3 月，在 DODTR 中检索所有有任何院前活动（例如干预、运输、生命体征）记录的病例，并检索所有可用的医院数据。我们从搜索中排除了没有记录院前活动的伤亡人员。共有 28950 例符合纳入标准。其中，25897 例（89.5%）为成年人，3053 例为儿童（10.5%）。遇到的伤亡人数呈稳步下降趋势，最明显的下降发生在 2014 年。美国军事人员伤亡人数构成了最大比例（n=10182）的受试者，其次是东道国平民（n=9637）。中位年龄为 24 岁（四分位距/IQR 21-29）。大多数是战斗伤害（78.6%），是持久自由行动（61.8%）和伊拉克自由行动（24.4%）的一部分。大多数人受爆炸物（52.1%）伤害，其次是火器（28.1%），四肢严重受伤（24.9%）最常见。损伤严重程度中位数为 9 分（四分位距 4-16），大多数患者存活至出院（95.0%）。少数人在其护理链中有记录的医务人员或战斗救生员（27.9%），也没有经过急救站（3.0%）。空中后送占主导地位（77.9%）。在我们的数据集内，部署的美国军事医疗系统为至少 28950 名战斗伤员提供了院前医疗护理，其中大多数是美国军事人员和东道国平民。自 2014 年以来，战斗伤员人数迅速下降，然而，按每次遭遇计算，程序量并没有明显下降。
