BATTLEFIELD TRAUMA

Statistics reflect that up to 90% of combat loss of life occurs before CAX ever reach an MTF. For this reason, management at the POI or wounding prior to CASEVAC is vital. Statistics also reveal that the KIA rate in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) (12.5%) is half of what it was in World War II (25.3%) and a third less than Vietnam and Desert Shield/Storm (18.6%). CAX with uncontrolled hemorrhage compose the largest group of potentially preventable deaths on the battlefield. Statistically, the deaths that occur on today’s battlefield result from the following:

• Penetrating traumatic brain injury (TBI). Most of these cases are not survivable, and these CAX are triaged as expectant.


• Surgically-uncorrectable torso trauma. Trauma to this region has significantly decreased due in part to the use of Interceptor Body Armor/Improved Outer Tactical Vest; however, trauma to unprotected areas, such as the axillary region, still occurs and is frequently not survivable. Penetrating wounds to the abdomen, without significant vascular involvement, may be survivable for several hours.


• Potentially correctable surgical trauma.


• Exsanguination; hemorrhage from extremity wounds remains the leading cause of preventable death. Extremity wounds account for over 60% of all wounds on today’s battlefield.


• Mutilating blast trauma. These horrific wounds are not usually survivable. Improvised explosive devices (IEDs)/vehicle-borne IEDs (VBIEDs) are the leading cause of morbidity and mortality in OIF/OEF.


• Tension pneumothorax (PTX). This is the second leading cause of death on the battlefield. Penetrating chest trauma still exists, even with the advent of body armor, and can become rapidly fatal without timely medical intervention.


• Airway obstruction/injury; the third leading cause of preventable death. While this is a small percentage, mostly due to maxillofacial trauma, these injuries require immediate attention to ensure survivability of CAX.


• Died of wounds, mainly due to infection and shock.

The primary types of wounds caused by weapons are penetrating, blast, and thermal trauma. Unlike the civilian community where the majority of wounds (70%) are blunt trauma in nature, usually from motor vehicle crashes, the majority of wounds in combat are caused by penetrating injuries from bullets (23%), shrapnel injuries (62%), and blast injuries (3%). Secondary debris is also frequently associated with these types of penetrating wounds.

Note: IEDs/VBIEDs have caused about half of all American CAX in OIF and about 30% of combat CAX in OEF, both KIA and wounded in action.

Exsanguination, PTX, and airway obstruction/injuries are significant because they are potentially avoidable with appropriate medical management and intervention using SOF combat casualty care principles and techniques. In fact, it is estimated that of all preventable deaths, 90% might be avoided with the simple application of a tourniquet for extremity hemorrhage, rapid management of a PTX, and the establishment of a viable airway.





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