Joint Trauma System, Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA.
Department of Military and Emergency Medicine (Kotwal), Department of Pathology (Rohrer, Mazuchowski), Department of Radiology (Harcke), Department of Surgery (Gurney, Shackelford), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2023 Aug 29;188(9-10):3045-3056. doi: 10.1093/milmed/usac119.
Military operations provide a unified action and strategic approach to achieve national goals and objectives. Mortality reviews from military operations can guide injury prevention and casualty care efforts.
A retrospective study was conducted on all U.S. military fatalities from Operation Inherent Resolve (OIR) in Iraq (2014-2021) and Operation Freedom's Sentinel (OFS) in Afghanistan (2015-2021). Data were obtained from autopsy reports and other existing records. Fatalities were evaluated for population characteristics; manner, cause, and location of death; and underlying atherosclerosis. Non-suicide trauma fatalities were also evaluated for injury severity, mechanism of death, injury survivability, death preventability, and opportunities for improvement.
Of 213 U.S. military fatalities (median age, 29 years; male, 93.0%; prehospital, 89.2%), 49.8% were from OIR, and 50.2% were from OFS. More OIR fatalities were Reserve and National Guard forces (OIR 22.6%; OFS 5.6%), conventional forces (OIR 82.1%; OFS 65.4%), and support personnel (OIR 61.3%; OFS 33.6%). More OIR fatalities also resulted from disease and non-battle injury (OIR 83.0%; OFS 28.0%). The leading cause of death was injury (OIR 81.1%; OFS 98.1%). Manner of death differed as more homicides (OIR 18.9%; OFS 72.9%) were seen in OFS, and more deaths from natural causes (OIR 18.9%; OFS 1.9%) and suicides (OIR 29.2%; OFS 6.5%) were seen in OIR. The prevalence of underlying atherosclerosis was 14.2% in OIR and 18.7% in OFS. Of 146 non-suicide trauma fatalities, most multiple/blunt force injury deaths (62.2%) occurred in OIR, and most blast injury deaths (77.8%) and gunshot wound deaths (76.6%) occurred in OFS. The leading mechanism of death was catastrophic tissue destruction (80.8%). Most fatalities had non-survivable injuries (80.8%) and non-preventable deaths (97.3%).
Comprehensive mortality reviews should routinely be conducted for all military operation deaths. Understanding death from both injury and disease can guide preemptive and responsive efforts to reduce death among military forces.
军事行动为实现国家目标提供了统一的行动和战略方法。军事行动中的死亡率审查可以指导伤害预防和伤员护理工作。
对 2014 年至 2021 年在伊拉克进行的“固有决心行动”（OIR）和 2015 年至 2021 年在阿富汗进行的“自由哨兵行动”（OFS）中所有美国军事死亡人员进行了回顾性研究。数据来自尸检报告和其他现有记录。对死亡人员的人口特征、死亡方式、原因和地点以及潜在动脉粥样硬化进行了评估。还对非自杀性创伤死亡人员的伤害严重程度、死亡机制、伤害存活率、死亡可预防性和改进机会进行了评估。
在 213 名美国军事死亡人员中（中位年龄 29 岁；男性 93.0%；院前 89.2%），49.8%来自 OIR，50.2%来自 OFS。更多 OIR 死亡人员来自预备役和国民警卫队（OIR 22.6%；OFS 5.6%）、常规部队（OIR 82.1%；OFS 65.4%）和支援人员（OIR 61.3%；OFS 33.6%）。更多 OIR 死亡人员还死于疾病和非战斗伤害（OIR 83.0%；OFS 28.0%）。主要死因是伤害（OIR 81.1%；OFS 98.1%）。死亡方式不同，因为在 OFS 中看到更多的杀人案（OIR 18.9%；OFS 72.9%），而在 OIR 中看到更多的自然原因死亡（OIR 18.9%；OFS 1.9%）和自杀（OIR 29.2%；OFS 6.5%）。OIR 中潜在动脉粥样硬化的患病率为 14.2%，OFS 中为 18.7%。在 146 名非自杀性创伤死亡人员中，大多数多发/钝性力损伤死亡（62.2%）发生在 OIR，而大多数爆炸伤死亡（77.8%）和枪伤死亡（76.6%）发生在 OFS。主要死亡机制是灾难性组织破坏（80.8%）。大多数死亡人员的伤害不可存活（80.8%），死亡不可预防（97.3%）。
应对所有军事行动死亡人员进行全面的死亡率审查。了解伤害和疾病导致的死亡情况，可以指导预防和应对措施，以减少军队中的死亡人数。
