The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq

Kotwal, Russ S; Scott, Laura; Janak, Jud C.; Tarpey, Bruce W.; Howard, Jeffrey T.; Mazuchowski, Edward L.; Butler, Frank K.; Shackelford, Stacy; Gurney, Jennifer M; Stockinger, Zsolt T.

doi:10.1097/ta.0000000000001798

Cited by 59 publications

(69 citation statements)

References 23 publications

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“…Consistent data support the benefit of prehospital transfusion . Delayed evacuation further reinforces the importance of blood products being available closer to the site of injury and during evacuation, which justifies the provision of French lyophilized plasma (FLYP) for ground Role 1 medical teams and the transfusion of plasma and RBC during MEDEVAC since 2016 …”

Section: Discussionmentioning

confidence: 73%

“…Consistent data support the benefit of prehospital transfusion. 2,3,[25][26][27][28] Delayed evacuation further reinforces the importance of blood products being available closer to the site of injury and during evacuation, which justifies the provision of French lyophilized plasma (FLYP) for ground Role 1 medical teams and the transfusion of plasma and RBC during MEDE-VAC since 2016. 13,14 Vitalis et al 13 described that 25% of Alpha casualties received prehospital transfusion in a similar area of operations between April 2016 and April 2017.…”

Section: Optimization Of Prehospital Transfusion Strategiesmentioning

confidence: 96%

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Five years of prolonged field care: prehospital challenges during recent French military operations

et al. 2019

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BACKGROUND French military operations in the Sahel conducted since 2013 over more than 5 million square kilometers have challenged the French Military Health Service with specific problems in prolonged field care. STUDY DESIGN AND METHODS To describe these challenges, we retrospectively analyzed the prehospital data from the first 5 years of these operations within a delimited area. RESULTS One hundred eighty‐three servicemen of different nationalities were evacuated, mainly as a result of explosions (73.2%) or gunshots (21.9%). Their mean number evacuation was 2.2 (minimum, 1; maximum, 8) per medical evacuation with a direct evacuation from the field to a Role 2 medical treatment facility (MTF) for 62% of them. For the highest‐priority casualties (N = 46), the median time [interquartile range] from injury to a Role 2 MTF was 130 minutes [70 minutes to 252 minutes], exceeding 120 minutes in 57% of cases and 240 minutes in 26%. The most frequent out‐of‐hospital medical interventions were external hemostasis, airway and hemopneumothorax management, hypotensive resuscitation, analgesia, immobilization, and antibiotic administration. Prehospital transfusion (RBCs and/or lyophilized plasma) was started three times in the field, two times during helicopter medical evacuation, and five times in tactical fixed wing medical aircraft. Lyophilized plasma was confirmed to be particularly suitable in these settings. One of the specific issues involved in lengthy prehospital time was the importance to reassess and convert tourniquets prior to Role 2 MTF admission. CONCLUSION Main challenges identified include reducing evacuation times as much as possible, preserving ground deployment of sufficiently trained medics and medical teams, optimization of transfusion strategies, and strengthening specific prolonged field care equipment and training.

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Section: Discussionmentioning

confidence: 73%

Section: Optimization Of Prehospital Transfusion Strategiesmentioning

confidence: 96%

Five years of prolonged field care: prehospital challenges during recent French military operations

et al. 2019

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“…The time from injury to definitive control of hemorrhage can vary dramatically according to circumstances. Although differences in prehospital transport times has little effect on mortality in hemodynamically stable patients, both military and civilian analyses indicate prehospital transport times are associated with an increased risk of mortality in patients with signs of active bleeding [1,2].…”

Section: Introductionmentioning

confidence: 99%

Biosurgicals and Trauma

Aucar¹,

Punja²,

Asensio³

2019

Biosurgicals - The Next Frontier in Operative Approaches [Working Title]

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Hemorrhage plays a prominent role in the outcome of trauma patients, from initial injury, through resuscitation, and stabilization. Biosurgicals have recently drawn attention to both the control of bleeding and chronic wound management. However, their role will be examined here in the context of adjuncts to control preoperative, intraoperative, and postoperative bleeding in trauma. A review of the scientific literature relevant to the use of passive and active topical hemostatic devices, as well as systemic pharmacologic agents, for control of hemorrhage is provided, in both military and civilian contexts. Bibliometric publication patterns and published guidelines are examined to identify the range of individual products available and the degree of attention they receive in the management of acute traumatic injuries. It is imperative that the evidentiary basis for the use of these agents be weighed against their cost and potential risks.

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“…In addition, recognizing that more rapid transport to surgical hospitals is not always possible, recent trauma system advances have also focused on bringing additional resuscitation capabilities (remote damage control resuscitation) to the seriously injured in the form of prehospital blood transfusion; advanced hemostatic interventions; and light, maneuverable surgical teams . Prehospital transfusion in particular has been associated with improved survival in combat casualties . Not all studies of prehospital transfusion have demonstrated a survival benefit.…”

mentioning

confidence: 99%

“…16,43 Prehospital transfusion in particular has been associated with improved survival in combat casualties. 44 Not all studies of prehospital transfusion have demonstrated a survival benefit. However, an analysis of the time to transfusion among evacuated US military combat causalities in Afghanistan demonstrated that blood product transfusion within 36 minutes of injury was associated with improved survival.…”

mentioning

confidence: 99%

Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury

2019

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The majority of potentially preventable deaths after trauma are related to hemorrhage and occur early after injury, with the largest number of deaths occurring before hospital arrival. Approximately one‐fourth of trauma deaths may be potentially preventable through early medical and surgical interventions. Interventions dedicated to bleeding control and hemostatic resuscitation have demonstrated merit in decreasing hemorrhagic injury mortality. Advancing these novel strategies to the casualty in the prehospital phase of care, particularly in tactical or austere environments, may prove beneficial for hemorrhage mitigation to temporize the window of survival to definitive care. Future studies of resuscitation and survival after traumatic injury must include analysis of prehospital deaths to fully understand the outcomes of early interventions.

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The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq

Abstract: Performance improvement and epidemiological, level IV.

Cited by 59 publications

References 23 publications

Five years of prolonged field care: prehospital challenges during recent French military operations

Five years of prolonged field care: prehospital challenges during recent French military operations

Biosurgicals and Trauma

Outcomes of traumatic hemorrhagic shock and the epidemiology of preventable death from injury

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