Now and Then: Combat Casualty Care Policies for Operation Iraqi Freedom and Operation Enduring Freedom Compared With Those of Vietnam

Cordts, Paul R.; Brosch, Laura A.; Holcomb, John B.

doi:10.1097/ta.0b013e31816093bd

Cited by 28 publications

(14 citation statements)

References 20 publications

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“…This approach has proven very effective, and continues to save lives in combat. [13][14][15] Fisher & 2013 Prehospital and Disaster Medicine More recent data have suggested that the incidence of airway compromise in combat is similar to that reported in the WDMET study. Autopsy data from two periods in Operation Enduring Freedom (OEF) in Afghanistan and Operation Iraqi Freedom (OIF) in Iraq identified 982 fatalities, including 232 cases with potentially survivable injuries.…”

Section: Discussionsupporting

confidence: 56%

Incidence of Fatal Airway Obstruction in Police Officers Feloniously Killed in the Line of Duty: A 10-Year Retrospective Analysis

Fisher

Callaway

Sztajnkrycer

2013

Prehosp. Disaster med.

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The limited LEOKA data suggests that acute airway obstruction secondary to penetrating trauma appears to be a rare cause of possibly preventable death in police officers. Based upon the nature of airway trauma, nasopharyngeal airways would not be expected to be an effective lifesaving intervention. This study highlights the requirement for a comprehensive mortality and "near miss" database for law enforcement officers.

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Section: Discussionsupporting

confidence: 56%

Incidence of Fatal Airway Obstruction in Police Officers Feloniously Killed in the Line of Duty: A 10-Year Retrospective Analysis

Fisher

Callaway

Sztajnkrycer

2013

Prehosp. Disaster med.

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“…(92, 93) The Department of Defense Trauma Registry (DoDTR) is the largest and most comprehensive database of wartime wounded patients ever assembled, enabling the evaluation of over 57,000 soldiers with trauma-related injuries between 2002 and 2011. (13, 29,31, 92, 93) Research has attempted to address infectious complications of war wounds. This has included several studies focusing on interventions at the point of injury.…”

Section: Research In the Trauma Zonementioning

confidence: 99%

Lessons of war

Blyth

Yun

Tribble³

et al. 2015

Journal of Trauma and Acute Care Surgery

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Summary In over a decade of war, numerous advancements have been made to improve overall combat-related mortality, but infectious complications remain a leading cause of both morbidity and mortality in combat-related injured personnel. Here we will attempt to compare the challenges and lessons of combat-related injuries and infections from the Vietnam War with those of OIF/OEF. Throughout the Vietnam War and OIF/OEF, there have been similar infection-related challenges faced in caring for combat-related trauma patients. Both conflicts reinforced the importance of rapid medical evacuation and definitive surgical management of war wounds. They revealed the constant evolution of infecting organisms and the challenge of increasing antimicrobial resistance. We have also seen that with decreased mortality of severely injured personnel new morbidities must be addressed. Using the foundation of fragmented research from the Vietnam War, previously successful models were assembled into joint service research institutions which have allowed these questions to be addressed. However, many questions regarding measures to reduce infectious complications in our combat-injured personnel remain unanswered. Continued research building on established knowledge is critical for continued improvements in the care of combat-related trauma patients.

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“…These results are consistent with recent studies in civilian populations and professional athletes and support the growing body of literature suggesting that TBIs throughout the lifespan are associated with adverse effects on the brain. Furthermore, these findings raise concern about the consequences of blast-related injuries in today's veterans 36,37 as well as the growing rate of TBIs in the civilian population. 38,39 …”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Traumatic brain injury and risk of dementia in older veterans

et al. 2014

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Objectives: Traumatic brain injury (TBI) is common in military personnel, and there is growing concern about the long-term effects of TBI on the brain; however, few studies have examined the association between TBI and risk of dementia in veterans.Methods: We performed a retrospective cohort study of 188,764 US veterans aged 55 years or older who had at least one inpatient or outpatient visit during both the baseline (2000)(2001)(2002)(2003) and follow-up (2003-2012) periods and did not have a dementia diagnosis at baseline. TBI and dementia diagnoses were determined using ICD-9 codes in electronic medical records. Fine-Gray proportional hazards models were used to determine whether TBI was associated with greater risk of incident dementia, accounting for the competing risk of death and adjusting for demographics, medical comorbidities, and psychiatric disorders.Results: Veterans were a mean age of 68 years at baseline. During the 9-year follow-up period, 16% of those with TBI developed dementia compared with 10% of those without TBI (adjusted hazard ratio, 1.57; 95% confidence interval: 1.35-1.83). There was evidence of an additive association between TBI and other conditions on risk of dementia.Conclusions: TBI in older veterans was associated with a 60% increase in the risk of developing dementia over 9 years after accounting for competing risks and potential confounders. Our results suggest that TBI in older veterans may predispose toward development of symptomatic dementia and raise concern about the potential long-term consequences of TBI in younger veterans and civilians. There is growing evidence that traumatic brain injury (TBI) is associated with a variety of shortand long-term adverse health outcomes. A 2008 Institute of Medicine report concluded that TBIs are consistently associated with an increased risk of unprovoked seizures, premature mortality, and neurocognitive deficits in the affected region, with evidence strongest for penetrating wounds and severe or moderate TBIs.1 However, prior research on the relationship between TBI and risk of Alzheimer disease (AD) and all-cause dementia has been mixed. [2][3][4][5][6][7][8][9][10][11][12][13][14] Most prior studies have not adequately controlled for potential confounders, such as medical and psychiatric comorbidities, and none have considered death as a competing risk.Furthermore, to our knowledge, only one prior study has specifically focused on examining the relationship between TBI and risk of dementia in veterans.11 Many veterans have other combatrelated risk factors such as posttraumatic stress disorder (PTSD) and depression, which have been associated with an increased risk of dementia in veterans in prior studies, 15,16 and could act as either confounders or effect modifiers of the association between TBI and dementia in veterans.

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Now and Then: Combat Casualty Care Policies for Operation Iraqi Freedom and Operation Enduring Freedom Compared With Those of Vietnam

Abstract: It is important to recognize that both then and now, medical practice has been a reflection of the current state of medical practice, and that in both conflicts military medical personnel have been equally devoted to saving lives of combat casualties.

Cited by 28 publications

References 20 publications

Incidence of Fatal Airway Obstruction in Police Officers Feloniously Killed in the Line of Duty: A 10-Year Retrospective Analysis

Incidence of Fatal Airway Obstruction in Police Officers Feloniously Killed in the Line of Duty: A 10-Year Retrospective Analysis

Lessons of war

Traumatic brain injury and risk of dementia in older veterans

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