Improved Battlefield Care Decreases Combat Mortality

Increased use of tourniquets, blood transfusions, and speedier prehospital transport time accounted for 44.2% of the total mortality reduction seen over time in Afghanistan and Iraq, according to a new study.

Researchers from the U.S. Army Medical Research & Materiel Command (MRMC; Fort Detrick, MD, USA), the U.S. Defense Health Agency (DHA; Falls Church, VA, USA), the University of Texas Health Science Center (San Antonio, USA), and other institutions conducted a retrospective analysis of data on all 56,763 U.S. casualties and soldiers injured in battle in Afghanistan and Iraq from October 2001 to December 31, 2017.

Casualty outcomes were compared over different periods of time with ratios of the use of tourniquets, blood transfusions, and transport to a surgical facility within 60 minutes. Main outcomes and measures were casualty status--alive, killed in action (KIA), or died of wounds (DOW)--and case-fatality rate (CFR). The researchers found that from early to later stages of the conflicts, CFR decreased in Afghanistan (from 20 to 8.6%), and in Iraq (from 20.4 to 10.1%). For critically injured casualties, survival increased in Afghanistan (from 2.2 to 39.9%) and in Iraq (from 8.9 to 32.9%).

In simulations using data from 23,699 individual casualties, without the interventions assessed, CFR would likely have been higher in Afghanistan and Iraq, equivalent to 3,672 additional deaths. Of these deaths, 44.2% were associated with the interventions studied: 12.9% with use of tourniquets, 23.8% for blood transfusions, and 7.5% for reduction in prehospital transport times. In all, a three-fold increase in survival among the most critically injured casualties was observed during the course of the conflicts. The study was published on March 27, 2019, in JAMA Surgery.

“Across 16 years of conflict, military trauma system advancements, namely, improvements in methods to control bleeding, replace blood, and reduce time to treatment, may be associated with increased survival of battle casualties,” concluded lead author Jeffrey Howard, PhD, of UTHSCSA, and colleagues. “More critically injured casualties reached surgical care, with increased survival, implying improvements in prehospital and hospital care.”

Related Links:
U.S. Army Medical Research & Materiel Command
U.S. Defense Health Agency
University of Texas Health Science Center