The U.S. military services, drawing on the experiences of civilian trauma systems in monitoring trauma care delivery, have begun to implement their own registries, emphasizing injury incidence and severity in a combat environment. This article introduces and describes the development of the U.S. Navy-Marine Corps Combat Trauma Registry and presents several preliminary inquiries of its database regarding combat injury patterns and casualty management during Operation Iraqi Freedom. The Navy-Marine Corps Combat Trauma Registry is composed of data sets describing events that occur from the point of injury through the medical chain of evacuation and on to long-term rehabilitative outcomes. Data were collected from Navy-Marine Corps level 1B, 2, and 3 medical treatment facilities. Data from the official combat period were analyzed to present a variety of preliminary findings that indicate, among other things, how many and for what type of injury casualties were evacuated, specific mechanisms of injury, and types of injuries treated at the medical treatment facilities.

This investigation examined the wounds incurred by 279 U.S. Navy-Marine personnel (97% Marines and 3% sailors) identified as wounded in action during Operation Iraqi Freedom, from March 23 through April 30, 2003. The goal was to assess the potential impact of each causative agent by comparing the differences in anatomical locations, types of injuries caused, and medical specialists needed to treat the casualties. The overall average number of diagnoses per patient was 2.2, and the overall average number of anatomical locations was 1.6. The causative agents were classified into six major categories, i.e., small arms, explosive munitions, motor vehicle accidents, falls, weaponry accidents, and other/unknown. Explosive munitions and small arms accounted for approximately three of four combat-related injuries. Upper and lower extremities accounted for approximately 70% of all injuries, a percentage consistent for battlefield injuries since World War II.

Combat amputees had a complex set of outcomes supporting the continued need for military amputee care programs.

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Our data indicate that musculoskeletal extremity injuries in sex- and age-diverse populations comprised the majority of clinical diagnoses. Current capabilities and surgical staffing of hospital ships and CRTS platforms influenced their respective DR operations, including the volume and types of surgical care delivered.

Abstract-Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressuretolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.

Background: Posttraumatic stress disorder (PTSD) and hearing loss are hallmark public health issues related to military service in Iraq and Afghanistan. Although both are significant individual contributors to disability among veterans, their co-occurrence has not been specifically explored. Methods: A total of 1179 male U.S. military personnel who sustained an injury between 2004 and 2012 during operations in Iraq or Afghanistan were identified from clinical records. Pre-and postinjury audiometric data were used to define new-onset hearing loss, which was categorized as unilateral or bilateral. Diagnosed PTSD was abstracted from electronic medical records. Logistic regression analysis examined the relationship between hearing loss and PTSD, while adjusting for age, year of injury, occupation, injury severity, injury mechanism, and presence of concussion. Results: The majority of the study sample were aged 18-25 years (79.9%) and sustained mild-moderate injuries (94.6%). New-onset hearing loss was present in 14.4% of casualties (10.3% unilateral, 4.1% bilateral). Rates of diagnosed PTSD were 9.1, 13.9, and 29.2% for those with no hearing loss, unilateral hearing loss, and bilateral hearing loss, respectively. After adjusting for covariates, those with bilateral hearing loss had nearly three-times higher odds of PTSD (odds ratio = 2.92; 95% CI, 1.47-5.81) compared to those with no hearing loss. Unilateral hearing loss was not associated with PTSD. Conclusions: Both PTSD and hearing loss are frequent consequences of modern warfare that adversely affect the overall health of the military. Bilateral, but not unilateral, hearing loss was associated with a greater burden of PTSD. This has implications for warfighter rehabilitation and should encourage collaboration between audiology and mental health professionals.

Introduction Ketamine is an alternative to opioids for prehospital analgesia following serious combat injury. Limited research has examined prehospital ketamine use, associated injuries including traumatic brain injury (TBI) and PTSD outcomes following serious combat injury. Materials and Methods We randomly selected 398 U.S. service members from the Expeditionary Medical Encounter Database who sustained serious combat injuries in Iraq and Afghanistan, 2010-2013. Of these 398 patients, 213 individuals had charted prehospital medications. Clinicians reviewed casualty records to identify injuries and all medications administered. Outcomes were PTSD diagnoses during the first year and during the first 2 years postinjury extracted from military health databases. We compared PTSD outcomes for patients treated with either (a) prehospital ketamine (with or without opioids) or (b) prehospital opioids (without ketamine). Results Fewer patients received prehospital ketamine (26%, 56 of 213) than only prehospital opioids (69%, 146 of 213) (5%, 11 of 213 received neither ketamine nor opioids). The ketamine group averaged significantly more moderate-to-serious injuries, particularly lower limb amputations and open wounds, compared with the opioid group (Ps < .05). Multivariable regressions showed a significant interaction between prehospital ketamine (versus opioids) and TBI on first-year PTSD (P = .027). In subsequent comparisons, the prehospital ketamine group had significantly lower odds of first-year PTSD (OR = 0.08, 95% CI [0.01, 0.71], P = .023) versus prehospital opioids only among patients who did not sustain TBI. We also report results from separate analyses of PTSD outcomes among patients treated with different prehospital opioids only (without ketamine), either morphine or fentanyl. Conclusions The present results showed that patients treated with prehospital ketamine had significantly lower odds of PTSD during the first year postinjury only among patients who did not sustain TBI. These findings can inform combat casualty care guidelines for use of prehospital ketamine and opioid analgesics following serious combat injury.