Assessing the evolution of pre-hospital combat casualty care: A comparative study of two conflicts a decade apart.
The American journal of emergency medicine · 2024-11-24 · Registry study
Abstract
BACKGROUND: Combat casualty care has advanced significantly with the implementation of evidence-based protocols designed to lower combat-related mortality. Over the last decade, two major urban conflicts in southern Israel have challenged the evolving military trauma system. This study aimed to assess differences in prehospital care and compare the outcomes of aeromedically evacuated casualties from the 2014 and 2023 conflicts. METHODS: This retrospective registry-based cohort study utilized records from the Military Airborne Combat Evacuation Unit (MACEU) and the Israeli National Trauma Registry. Eligible patients evacuated by MACEU between 07.17.14 and 08.16.14 and between 10.27.23 and 03.17.24 were compared. Ground-evacuated casualties were excluded. Demographics, prehospital interventions, and clinical outcomes were compared. RESULTS: During the 2014 conflict, 251 patients were evacuated alive, compared to 940 in 2023. Both conflicts involved mostly young males injured by explosions, with comparable injury distributions across body regions. The time from injury to hospital arrival decreased from 65 min (IQR 47-94) in 2014 to 60 min (IQR 47-180) in 2023 (d = 0.5, p < 0.001). The proportion of severely injured patients (ISS ≥ 16) increased from 18.3 % to 25.2 % (OR 1.5 [95 % CI 1.06-2.14], p = 0.03), and critically injured patients (ISS ≥ 25) from 7.6 % to 12.8 % (OR 1.79 [95 % CI 1.08-2.96], p = 0.03). Prehospital advanced airway interventions and tube thoracostomies decreased from 11.6 % to 6.0 % (OR 0.48 [95 % CI 0.30-0.76], p < 0.001) and from 7.0 % to 2.1 % (OR 0.28 [95 % CI 0.15-0.54], p < 0.001), respectively. Prehospital blood transfusions use increased from 6.6 % to 16.4 % (OR 2.78 [95 % CI 1.64-4.76], p < 0.001). In-hospital mortality rates remained stable (2.7 % vs. 2.5 %, OR 1.12 [95 % CI 0.44-2.81], p = 0.99). Although not statistically significant, lower mortality rates were recorded among the severely (13.0 % vs. 8.4 %, OR 0.61 [95 % CI 0.23-1.61, p = 0.48) and critically injured (26.3 % vs. 15.8 %, OR 0.53 [95 % CI 0.17-1.64], p = 0.32). CONCLUSION: Over the past decade, there has been a decline in prehospital airway interventions and thoracostomies, coupled with an increase in early blood transfusions. Despite greater injury severity, mortality rates have remained stable. Although not statistically significant, lower mortality rates were recorded among the severely and critically injured. These findings support the "less is more" approach in modern prehospital combat casualty care.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Helicopter & air ambulance · Military & tactical · Mortality & survival · Thoracostomy · Time intervals · Urban
Related articles
- The Effect of a Golden Hour Policy on the Morbidity and Mortality of Combat Casualties. (JAMA Surg, 2016)
- A Review of Casualties Transported to Role 2 Medical Treatment Facilities in Afghanistan. (Mil Med, 2018)
- A review of the first 10 years of critical care aeromedical transport during operation iraqi freedom and operation enduring freedom: the importance of evacuation timing. (JAMA Surg, 2014)
- Influence of Time to Transport to a Higher Level Facility on the Clinical Outcomes of US Combat Casualties with TBI: A Multicenter 7-Year Study. (Mil Med, 2020)
- Optimizing aeromedical evacuation in combat: Balancing trauma system efficiency and patient outcomes. (J Trauma Acute Care Surg, 2026)
- Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival. (JAMA, 2017)