Analysis of Casualties That Underwent Airway Management Before Reaching Role 2 Facilities in the Afghanistan Conflict 2008–2014

Hudson, Ian; Blackburn, Megan B; Staudt, Amanda M; Ryan, Kathy L.; Mann-Salinas, Elizabeth

doi:10.1093/milmed/usz383

Cited by 7 publications

(12 citation statements)

References 32 publications

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“…Hemorrhage control, airway, and ventilatory support are potentially lifesaving and highly time-critical, resource-intensive interventions that were often initiated prehospital for casualties in this study as well as previous studies. 10,14,16,17 During the timeframe of this study, prehospital transfusion was administered in 4% of nonsurvivors. Blood products were gradually made available on medical evacuation platforms starting in 2012.…”

Section: Discussionmentioning

confidence: 99%

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations

Shackelford¹,

Junco²,

Riesberg³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Quantification of medical interventions administered during prolonged field care (PFC) is necessary to inform training and planning. MATERIALS AND METHODS: Retrospective cohort study of Department of Defense Trauma Registry casualties with maximum Abbreviated Injury Scale (MAIS) score of 2 or greater and prehospital records during combat operations 2007 to 2015; US military nonsurvivors were linked to Armed Forces Medical Examiner System data. Medical interventions administered to survivors of 4 hours to 72 hours of PFC and nonsurvivors who died prehospital were compared by frequency-matching on mechanism (explosive, firearm, other), injury type (penetrating, blunt) and injured body regions with MAIS score of 3 or greater. Covariates for adjustment included age, sex, military Service, shock, Glasgow Coma Scale, transport team, MAIS and Injury Severity Score (ISS). Sensitivity analysis focused on US military subgroup with AIS/ISS assigned to nonsurvivors after autopsy. RESULTS: The total inception cohort included 16,202 casualties (5,269 US military, 10,809 non-US military), 64% Afghanistan, 36% Iraq. Of US military, 734 deaths occurred within 30 days, nearly 90% occurred within 4 hours of injury. There were 3,222 casualties (1,111 US military, 2,111 non-US military) documented for prehospital care and died prehospital (691) or survived 4 hours to 72 hours of PFC (2,531). Twenty-five percent (815/3,222) received advanced airway, 18% (583) ventilatory support, 9% (281) tourniquet. Twenty-three percent (725) received blood transfusions within 24 hours. Of the matched cohort (1,233 survivors, 490 nonsurvivors), differences were observed in care (survivors received more warming, intravenous fluids, sedation, mechanical ventilation, narcotics, antibiotics; nonsurvivors received more intubations, tourniquets, intraosseous fluids, cardiopulmonary resuscitation). Sensitivity analysis focused on US military (732 survivors, 379 nonsurvivors) showed no significant differences in prehospital interventions. Without autopsy information, the ISS of nonsurvivors significantly underestimated injury severity. CONCLUSION: Tourniquets, blood transfusion, airway, and ventilatory support are frequently required interventions for the seriously injured. Prolonged field care should direct resources, technology, and training to field technology for sustained resuscitation, airway, and breathing support in the austere environment.

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Section: Discussionmentioning

confidence: 99%

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations

Shackelford¹,

Junco²,

Riesberg³

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

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“…Supplementary Table S1 details the findings of each included study; the quality of evidence findings are available in Supplementary Table S2 . 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 56 , 57 , 58 , 59 , 60 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 Thirty-three studies were low quality and 36 were very low quality. …”

Section: Resultsmentioning

confidence: 99%

“…55 Particularly in the military studies, the training behind the medical team performing FONA is not always clear as they are referred to as ‘combat medics’ or ‘military medics’. 26 , 30 , 52 , 56 , 57 , 58 , 59 , 60 There are also differences worldwide in the setup of prehospital teams and the standard FONA technique used; the 2017 guidelines were based on the UK DAS guidelines and may therefore not have been utilised outside of the UK. 5 , 61 There is also difficulty in extracting success rates before and after 2017 in datasets that overlap this time period with different techniques still being used despite the update in guidance.…”

Section: Discussionmentioning

confidence: 99%

“…complication rates could not be separated from failure rates). 56 , 58 , 60 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 If these studies reported FONA success rates, it may have altered the findings of this systematic review, particularly within certain population groups. As an example, Diggs and colleagues 63 would potentially add more than 1000 patients to the Emergency Medical Services group.…”

Section: Discussionmentioning

confidence: 99%

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Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis

Morton

Avery

Kua

et al. 2023

British Journal of Anaesthesia

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“…1 Our group previously analyzed several aspects of the role 2 level of care, including the injury 2 and procedure 3 burdens, the fatalities, 4 and specific interventions such as fresh whole blood resuscitation 5 and prehospital airway management. 6 However, a dedicated assessment of burn casualties treated at this level of care has not been performed to date. This assessment is important, as thermal injuries account for 5% to 20% of casualties during combat.…”

mentioning

confidence: 99%

Characteristics of burn casualties treated at role 2 in Afghanistan

Suresh

Staudt²,

Trevino³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Role 2 medical treatment facilities (MTFs) are frequently located in austere settings and have limited resources. A dedicated assessment of burn casualties treated at this level of care has not been performed. Therefore, the objective of this study was to characterize burn casualties presenting to role 2 MTFs in Afghanistan, along with the procedures they required, complications, and mortality to begin understanding the resources consumed by their care. METHODS:We identified burn casualties from the Department of Defense Trauma Registry (DODTR). The inclusion criteria were (1) experienced burn injuries in Afghanistan between October 2005 and April 2018 and (2) had documentation of treatment at role 2 in the DODTR. We excluded casualties with only first-degree burns, not otherwise specified burns, or only corneal burns. Casualty demographics, injury characteristics, procedures, and outcomes were reported. RESULTS:We identified 453 burn casualties with a median (interquartile range) Injury Severity Score of 10 (4-22) and percent total body surface area burned of 11 (5-30). There were 123 casualties (27.2%) with inhalation injury, and the casualties experienced 3,343 additional traumatic injuries and needed 2,530 procedures. Casualties with documentation of resuscitation information received a median (interquartile range) of 1.9 (0.7-3.7) L of crystalloid fluids. Complications were documented in 53 casualties (11.7%). Final mortality was reported in 36 casualties (8.0%), and mortality at role 2 MTFs was reported in 7 casualties (1.5%). CONCLUSION:Burn casualties had many injuries and needed many procedures, including those related to airway management, resuscitation, and wound care. Given the urgency of these procedures, ensuring that there is enough equipment and supplies will be important in the future. Although infrequent, some casualties experienced complications. Factors that may influence resuscitation include injury severity, concomitant traumatic injuries, and available supplies. Obtaining more contextual information on the patient care environment will be useful going forward.

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Analysis of Casualties That Underwent Airway Management Before Reaching Role 2 Facilities in the Afghanistan Conflict 2008–2014

Cited by 7 publications

References 32 publications

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations

Case-control analysis of prehospital death and prolonged field care survival during recent US military combat operations

Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis

Characteristics of burn casualties treated at role 2 in Afghanistan

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