From Paper to Digital Medical Documentation in the Field: The Rapid Development and Deployment of the Digital Casualty Card System During a War.
JMIR Medical Informatics · 2026-07-24 · Implementation & quality improvement
Abstract
BACKGROUND: The accurate documentation of medical treatments for combat-injured personnel has historically posed significant challenges for prehospital medical teams. During recent US Army conflicts in Afghanistan and Iraq, only 18%-25% of casualties had any form of prehospital documentation. In the Israel Defense Forces (IDF), traditional manual and paper-based documentation has proven inefficient. During the 2014 Israel-Hamas conflict in Gaza, the completion rate for full documentation was notably low; only 11% (82/704) of casualties had casualty cards from the field. The sudden outbreak of the 2023-2024 Israel-Hamas war required an immediate re-evaluation of battlefield medical documentation practices. The IDF identified an urgent need for an innovative documentation approach to address the challenges of managing and tracking casualties in high-pressure scenarios. The integration of this system underscores the importance of real-time, robust documentation in improving continuity of care, minimizing medical error, and enhancing operational efficiency. OBJECTIVE: This study outlines the rapid development and deployment of the Digital Casualty Card System (DCCS), designed to enhance the accuracy and efficiency of field documentation by medical teams during the 2023-2024 Israel-Hamas war. METHODS: The DCCS was designed to streamline real-time medical data capture, enhance information transfer along the evacuation chain, and improve battlefield casualty care. A strategic decision was made to prioritize rapid deployment by focusing on a user-friendly, digital application, deliberately excluding advanced features such as sensor integration and real-time data transfer between echelons. This system became operational within 2 weeks of the project's initiation and comprises military-grade tablets embedded with a dedicated software application for documenting casualty status and plastic memory cards worn around the casualty's neck for data transfer between medical teams. This study uses patient data from the IDF Trauma Registry, relying on data from point of injury casualty cards (DCCS), after-action reports, and data entry by on scene and en route providers. IMPLEMENTATION (RESULTS): Overall, since the beginning of the distribution, over 700 DCCS kits were embedded in combat units, medical evacuation units, and training units. During the ground operation in Gaza, out of 2984 casualties, 1175 (39%) arrived with DCCS documentation. CONCLUSIONS: The rapid development and deployment of DCCS during the ongoing war proved to be feasible and contributed to the substantial improvements in both documentation rates and the quality of data collected in the field compared to traditional paper-based casualty cards.
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Tags
Communication & handover · Implementation · Military & tactical
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