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.

The objective of this study was to evaluate the distributions of U.S. Marine Corps and Army wounded in action (WIA) and disease and nonbattle injury (DNBI) casualties during Operation Iraqi Freedom Major Combat Phase (OIF-1) and Support and Stability Phase (OIF-2). A retrospective review of hospitalization data was conducted. chi2 tests were used to assess the Primary International Classification of Diseases, 9th Revision (ICD-9), diagnostic category distributions by phase of operation, casualty type, and gender. Of the 13,071 casualties identified for analysis, 3,263 were WIA and 9,808 were DNBI. Overall, the proportion of WIA was higher during OIF-1 (36.6%) than OIF-2 (23.6%). Marines had a higher proportion of WIA and nonbattle injuries than soldiers. Although overall DNBI distributions for men and women were statistically different, their distributions of types of nonbattle injuries were similar. Identifying differences in injury and illness distributions by characteristics of the casualty population is necessary for military medical readiness planning.

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Approved for public release; distribution unlimited.

public release; distribution is unlimited. This research has been conducted in compliance with all applicable federal regulations governing the protection of human subjects in research. Summary ProblemModeling and simulation applications require accurate estimations of the number and type of injuries and illnesses.These estimates, called patient streams, include projections of the patient condition (PC) code frequencies needed for estimating medical resources for various types of military operations. They are the diagnostic nomenclature that modeling and simulation applications use. Currently, no quantitative process has been developed to estimate these patient streams. ObjectiveThe objective of this research was to develop a methodology that links hospitalization data to the PC code nomenclature. In addition, patient streams resulting from specific causative agents would be estimated by associating the traumas and anatomical locations that result from a specific weapon. Finally, a tool using this quantitative approach would be developed that allows the user to select one of these methods to easily calculate the patient distributions. ApproachTwo approaches to estimate PC code patient streams were addressed. The first approach linked trauma and anatomical location percentages to PC codes for selected operations. Diagnostic data obtained from Operation Iraqi Freedom (OIF) were grouped and coded to illustrate the estimation of a patient stream in terms of PC codes using the first approach. In the second approach, using OIF and Vietnam data, patient streams were estimated from the traumas resulting from the causative agents expected to be used by enemy forces. ResultsThe Patient Condition Occurrence Frequency (PCOF) tool was developed to allow the user to estimate various patient distributions based on operation type or causative agent. DiscussionThis study provides medical planners the ability to easily generate patient streams using a quantitative and a mathematical approach. These approaches provide patient streams from the different phases of OIF, and illustrate the potential application of the tool for generating patient streams for future operations in support of the global war on terror.2

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