Killed in action (KIA): an analysis of military personnel who died of their injuries before reaching a definitive medical treatment facility in Afghanistan (2004–2014)

Abstract

IntroductionThe majority of combat deaths occur before arrival at a medical treatment facility but no previous studies have comprehensively examined this phase of care.MethodsThe UK Joint Theatre Trauma Registry was used to identify all UK military personnel who died in Afghanistan (2004–2014). These data were linked to non-medical tactical and operational records to provide an accurate timeline of events. Cause of death was determined from records taken at postmortem review. The primary objective was to report time between injury and death in those killed in action (KIA); secondary objectives included: reporting mortality at key North Atlantic Treaty Organisation timelines (0, 10, 60, 120 min), comparison of temporal lethality for different anatomical injuries and analysing trends in the case fatality rate (CFR).Results2413 UK personnel were injured in Afghanistan from 2004 to 2014; 448 died, with a CFR of 18.6%. 390 (87.1%) of these died prehospital (n=348 KIA, n=42 killed non-enemy action). Complete data were available for n=303 (87.1%) KIA: median Injury Severity Score 75.0 (IQR 55.5–75.0). The predominant mechanisms were improvised explosive device (n=166, 54.8%) and gunshot wound (n=96, 31.7%).In the KIA cohort, the median time to death was 0.0 (IQR 0.0–21.8) min; 173 (57.1%) died immediately (0 min). At 10, 60 and 120 min post injury, 205 (67.7%), 277 (91.4%) and 300 (99.0%) casualties were dead, respectively. Whole body primary injury had the fastest mortality. Overall prehospital CFR improved throughout the period while in-hospital CFR remained constant.ConclusionOver two-thirds of KIA deaths occurred within 10 min of injury. Improvement in the CFR in Afghanistan was predominantly in the prehospital phase.

Using CT scans to determine the optimal sizes of hard armour plates to protect the torso for UK female Armed Forces personnel

“…A recent review demonstrated that 57% of Armed Forces personnel killed in action in contemporary conflict died immediately and >90% died within 1 hour of wounding. 1 This review included death from head injury, and when these patients are excluded, the proportion of immediate deaths is 29.7% and the deaths within 60 min of injury was 52.1%. 1 Personal armour exists to mitigate the injurious effect of war injury and a balance must be struck between high levels of protection and the mobility and comfort of the user.…”

Torso body armour coverage defined according to feasibility of haemorrhage control within the prehospital environment: a new paradigm for combat trauma protection

“…For this reason, we recommend that future consensus will be required about the effect extended timelines may have on the medical coverage required by personal armour. In addition, recent evidence has shown that between 2004 and 2014 during Iraq and Afghanistan, of the 448 UK Armed Forces personnel killed in action before medical treatment, 57% died immediately and 68% had died within 10 min 25. Improving survival in this cohort can only be achieved by primary or secondary prevention of tissue injury, with personal armour being a significant element.…”

Defining capabilities in deployed UK military prehospital emergency care

“…This care is delivered by personnel from a wide variety of career employment groups (CEG) as part of a system proven to be effective in saving lives 3. However, despite developments in military PHEC, the majority of combat deaths on recent operations occurred before arrival at a medical treatment facility 4. The continued innovation, development and effective employment of PHEC will be key to reducing mortality on future deployed operations 4.…”

“…However, despite developments in military PHEC, the majority of combat deaths on recent operations occurred before arrival at a medical treatment facility 4. The continued innovation, development and effective employment of PHEC will be key to reducing mortality on future deployed operations 4. In order to harness the maximum benefit of military PHEC capability, it is crucial that an operational clinical capability framework is clearly defined and understood by commanders, planners, staff officers and practitioners.…”

“…Effective delivery of military PHEC in an operational environment depends on personnel close to the point of injury or illness delivering immediate life-saving interventions followed by early involvement of specialist PHEC providers 3–5. Personnel responsible for PHEC can be divided into those who are directly employed and trained to deliver PHEC (vocational providers) and those who are trained to deliver this care as a secondary responsibility in addition to their main role (non-vocational providers).…”