Causes of Death in U.S. Special Operations Forces in the Global War on Terrorism

Holcomb, John B.; McMullin, Neil R.; Pearse, Lisa; Caruso, Jim; Wade, Charles E.; Oetjen-Gerdes, Lynne; Champion, Howard R.; Lawnick, Mimi; Farr, Warner D.; Rodriguez, Sam; Butler, Frank K.

doi:10.1097/01.sla.0000259433.03754.98

Cited by 602 publications

(369 citation statements)

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“…[7][8][9] These are also primarily responsible for severe ocular and ocular adnexal injuries, and have become a major source of ocular morbidity. 3 The detrimental effects of these explosive devices placed adjacent to the convoy route have been exacerbated through the use of secondary projectiles such as rocks, metal, or glass pieces.…”

Section: Discussionmentioning

confidence: 99%

Ocular injuries from improvised explosive devices

Erdurman

Hürmeriç

Gokce

et al. 2011

Eye

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Purpose To document the characteristics, treatments, and anatomical and functional outcomes of patients with ocular trauma from improvised explosive devices (IEDs). Methods Retrospective review of ocular injuries caused by IEDs, admitted to our tertiary referral centre. Results In total, sixty-one eyes of the 39 patients with an average age of 24 years (range, 20-42 years) were included in the study. In total, 49 (80%) eyes of the patients had open-globe and 12 (20%) had closed-globe injury.In eyes with open-globe injury, intraocular foreign body (IOFB) injury was the most frequently encountered type of injury, observed in 76% of eyes. Evisceration or enucleation was required as a primary surgical intervention in 17 (28%) of the eyes. Twentytwo (36%) eyes had no light perception at presentation. Patients were followed up for an average of 6 months (range, 4-34 months). At the last follow-up, 26 (43%) of 61 eyes had no light perception. Postoperative proliferative vitreoretinopathy (PVR) developed in 12 (50%) of the 24 eyes that underwent vitreoretinal surgery, and four of these eyes became phthisical. There were no cases of endophthalmitis. The presence of open-globe injury and presenting visual acuity worse than 5/200 were significantly associated with poor visual outcome (o5/200, Po0.05).In eyes with open-globe injury, the presence of an IOFB was not associated with poor visual outcome (P40.05). Conclusion Ocular injuries from IEDs are highly associated with severe ocular damage requiring extensive surgical repair or evisceration/enucleation. Postoperative PVR is a common cause of poor anatomical and visual outcome.

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Section: Discussionmentioning

confidence: 99%

Ocular injuries from improvised explosive devices

Erdurman

Hürmeriç

Gokce

et al. 2011

Eye

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“…[1][2][3][4] Data from recent conflicts involving US military personnel confirmed the continued importance of improving prehospital hemorrhage control. 3,[5][6][7] In response, the US Army implemented a design, testing, training, and fielding program for battlefield tourniquets, 8 -11 resulting in policy that all military personnel in theater carry tourniquets.…”

mentioning

confidence: 95%

Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma

Kragh¹,

Walters²,

Baer³

et al. 2009

Annals of Surgery

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509

243

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Objective: The purpose of this study was to determine if emergency tourniquet use saved lives. Summary Background Data: Tourniquets have been proposed as lifesaving devices in the current war and are now issued to all soldiers. Few studies, however, describe their actual use in combat casualties. Methods: A prospective survey of injured who required tourniquets was performed over 7 months in 2006 (NCT00517166 at ClinicalTrials.gov). Follow-up averaged 28 days. The study was at a combat support hospital in Baghdad. Among 2838 injured and admitted civilian and military casualties with major limb trauma, 232 (8%) had 428 tourniquets applied on 309 injured limbs. We looked at emergency tourniquet use, and casualties were evaluated for shock (weak or absent radial pulse) and prehospital versus emergency department (ED) tourniquet use. We also looked at those casualties indicated for tourniquets but had none used. We assessed survival rates and limb outcome. Results: There were 31 deaths (13%). Tourniquet use when shock was absent was strongly associated with survival (90% vs. 10%; P Ͻ 0.001). Prehospital tourniquets were applied in 194 patients of which 22 died (11% mortality), whereas 38 patients had ED application of which 9 died (24% mortality; P ϭ 0.05). The 5 casualties indicated for tourniquets but had none used had a survival rate of 0% versus 87% for those casualties with tourniquets used (P Ͻ 0.001). H emorrhage from injured extremities continues to be one of the leading sources of preventable death on the battlefield. 1-4 Data from recent conflicts involving US military personnel confirmed the continued importance of improving prehospital hemorrhage control. 3,[5][6][7] In response, the US Army implemented a design, testing, training, and fielding program for battlefield tourniquets, 8 -11 resulting in policy that all military personnel in theater carry tourniquets. As a result of this effort, tourniquets are now common on the battlefields of Iraq and Afghanistan, both in the hands of medical and nonmedical personnel.With the Tactical Combat Casualty Care initiative, the US military is not alone in establishing procedures and equipment for use of tourniquets in the prehospital environment by both medical and nonmedical personnel. 12,13 However, this renewed emphasis on tourniquets for prehospital hemorrhage control of extremity injuries is not agreed upon by all authors 14 -16 with some authors discouraging prehospital use of tourniquets altogether. [17][18][19][20] showed that tourniquet use is indicated in civilian trauma, albeit in a very small percentage of patients. However, the lifesaving capability of tourniquets has been unproven. Most of the controversy regarding the capacity of tourniquets to save lives versus tissue damage has been based more on speculation rather than actual data, as research in the human use of emergency tourniquets is limited. Clearly, the discussion would be better informed with actual data regarding these critical concerns. In 2003, we initiated data collection regarding e...

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confidence: 99%

“…1,2 Upon autopsy review, it was estimated that 15% to 20% of deaths that occur in combat were preventable with appropriate treatment, with 66% to 80% of these deaths occurring from hemorrhagic shock. 1,2 Death from severe traumatic injuries occurs quickly, usually within 6 hours to 12 hours from hospital admission. [3][4][5][6] Strategies or therapeutic principles that can be rapidly applied have the potential to prevent death from hemorrhagic shock and have a significant impact on improving survival for patients with traumatic injuries.…”

mentioning

confidence: 99%