The OFFICIAL Journal of the Special Operations Medical Association.

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First Blood: Fixing American Trauma Care

October 2017

Overhauling how citizens and medical providers respond to trauma, as well as how they collect and store blood, could save thousands of lives annually.

September 2018 Feature Article

Survey of Casualty Evacuation Missions Conducted by the 160th Special Operations Aviation Regiment During the Afghanistan Conflict

Summer 2018

Redman TT, Mayberry KE, Mora AG, Benedict BA, Ross EM, Mapp JG, Kotwal RS. 18(2). 79 - 85. (Journal Article)

Abstract

Background: Historically, documentation of prehospital combat casualty care has been relatively nonexistent. Without documentation, performance improvement of prehospital care and evacuation through data collection, consolidation, and scientific analyses cannot be adequately accomplished. During recent conflicts, prehospital documentation has received increased attention for point-of-injury care as well as for care provided en route on medical evacuation platforms. However, documentation on casualty evacuation (CASEVAC) platforms is still lacking. Thus, a CASEVAC dataset was developed and maintained by the 160th Special Operations Aviation Regiment (SOAR), a nonmedical, rotary-wing aviation unit, to evaluate and review CASEVAC missions conducted by their organization. Methods: A retrospective review and descriptive analysis were performed on data from all documented CASEVAC missions conducted in Afghanistan by the 160th SOAR from January 2008 to May 2015. Documentation of care was originally performed in a narrative after-action review (AAR) format. Unclassified, nonpersonally identifiable data were extracted and transferred from these AARs into a database for detailed analysis. Data points included demographics, flight time, provider number and type, injury and outcome details, and medical interventions provided by ground forces and CASEVAC personnel. Results: There were 227 patients transported during 129 CASEVAC missions conducted by the 160th SOAR. Three patients had unavailable data, four had unknown injuries or illnesses, and eight were military working dogs. Remaining were 207 trauma casualties (96%) and five medical patients (2%). The mean and median times of flight from the injury scene to hospital arrival were less than 20 minutes. Of trauma casualties, most were male US and coalition forces (n = 178; 86%). From this population, injuries to the extremities (n = 139; 67%) were seen most commonly. The primary mechanisms of injury were gunshot wound (n = 89; 43%) and blast injury (n = 82; 40%). The survival rate was 85% (n = 176) for those who incurred trauma. Of those who did not survive, most died before reaching surgical care (26 of 31; 84%). Conclusion: Performance improvement efforts directed toward prehospital combat casualty care can ameliorate survival on the battlefield. Because documentation of care is essential for conducting performance improvement, medical and nonmedical units must dedicate time and efforts accordingly. Capturing and analyzing data from combat missions can help refine tactics, techniques, and procedures and more accurately define wartime personnel, training, and equipment requirements. This study is an example of how performance improvement can be initiated by a nonmedical unit conducting CASEVAC missions.

Keywords: casualty evacuations; CASEVAC; en route care; Tactical Combat Casualty Care; TCCC

Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury

Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States Servicemembers injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events.

This report documents the remarkable decrease in casualties killed in action during the wars in Iraq and Afghanistan and the role of the Joint Trauma System, the CoTCCC, and the TCCC Working Group in helping to make that happen. It also outlines a clear and comprehensive vision for a National Trauma System that will enable the civilian and the military sectors to work in concert to help prevent ALL potentially preventable deaths in trauma victims.

What Our Readers are Saying

I just finished reading the fall edition of the JSOM and I am completely blown away!!!! It is absolutely packed with exceptional and relevant information that without a doubt, will assist SOF Tactical Health Care professionals in providing relevant and evidence based patient care. Thank you for providing what I consider a "World Class Medical Journal". The journal itself and the website have become my primary resource for knowledge in tactical medicine."

Robert M. Miller
North American Rescue
Chief Innovation Officer

"There is no peer-reviewed academic resource that equals the Journal of Special Operations Medicine for support of the medical and veterinary lead in Stabilization, Security, Transition and Reconstruction (SSTR) operations, combat and field medicine, and adaptation of Tactical Combat Casualty Care into Tactical Emergency Casualty Care for the law enforcement and emergency management community in 195 UN member countries. JSOM is a valuable resource as we continue the Millennium Medicine Project, targeting the global population that lacks access to basic surgical services and providing crisis management, security, and defense support in this demographic."

Stephen M. Apatow
President, Humanitarian Resource Institute
(UN:NGO:DESA) and H-II OPSEC: Defense Support:
Humanitarian and Security Operations

"Military units that have trained all of their members in Tactical Combat Casualty Care have documented the lowest incidence of preventable deaths among their casualties in the history of modern warfare - and JSOM is the first journal to publish every new change in TCCC."

Frank K. Butler, MD
Chairman, Committee on Tactical
Combat Casualty Care (CoTCCC)

"The past 30 years has brought an amazing professionalization of the specialty of Tactical Emergency Medical Support (TEMS). As new standards are set and the world faces increasingly complex security challenges, it is critical that the front line medical providers supporting military, intelligence, and law enforcement operations have a mechanism to expand their knowledge and share best practices. The Journal of Special Operations Medicine offers civilian readers access to the most cutting edge developments in the field including updates on Tactical Emergency Casualty Care (TECC), the National TEMS Imitative and Council (NTIC), and combat lessons learned. JSOM is the one-stop shop for best practice and future advancements in civilian TEMS. One of the unifying principles across humanitarian, expedition and disaster response medical operations is the ability to make complex decisions in uncertain environments. The Journal of Special Operations Medicine is one of the most unique platforms for experts to convey lessons learned and relevant scientific advances across specialties that historically have little interaction. Whether you work for Doctors Without Borders, a DMAT, or provide medical support for expeditions in austere environments, Journal of Special Operations Medicine is your journal."

David W. Callaway, MD
Director, Division of Operational and Disaster Medicine
Operational Medical Director, Carolinas MED-1
Co-Chairman, The Committee for Tactical Emergency Casualty Care (C-TECC)
Civilian Vice President, Special Operations Medical Association (SOMA)