Death on the Battlefield (2001- 2011): Implications for the future of combat casualty care

## Brian J. Eastridge, MD, Robert L. Mabry, MD, Peter Seguin, MD, Joyce Cantrell, MD, Terrill Tops, MD, Paul Uribe, MD, Olga Mallett, Tamara Zubko, Lynne Oetjen-Gerdes, Todd E. Rasmussen, MD, Frank K. Butler, MD, Russell S. Kotwal, MD, John B. Holcomb, MD, Charles Wade, PhD, Howard Champion, MD, Mimi Lawnick, Leon Moores, MD, and Lorne H. Blackbourne, MD

The Journal of Trauma and Acute Care Surgery

J Trauma Acute Care Surg, Volume 73, Number 6, Supplement 5

#### Description with Key Points:

Most battle?eld casualties died of their injuries before ever reaching a surgeon. As most pre-medical treatment facility (pre-MTF) deaths are nonsurvivable, mitigation strategies to impact outcomes in this population need to be directed toward injury prevention. To signi?cantly impact the outcome of combat casualties with potentially survivable (PS) injury, strategies must be developed to mitigate hemorrhage and optimize airway management or reduce the time interval between the battle?eld point of injury and surgical intervention.

Understanding battle?eld mortality is a vital component of the military trauma system. Emphasis on this analysis should be placed on trauma system optimization, evidence-based improvements in Tactical Combat Casualty Care guidelines, data-driven research, and development to remediate gaps in care and relevant training and equipment enhancements that will increase the survivability of the ?ghting force.

Death on the battlefield (2001 - 2011): Implications for the future of combat casualty care
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# Take Home Message:

Prehospital care is the most important aspect in ensuring the survival of the casualty.
Almost 90% of all combat deaths occur before the casualty reaches a Medical Treatment F acility (MTF)*
The fate of the injured often lies in the hands of the first responder. Of the prehospital deaths, 24.3% were deemed potentially survivable. (n = 976)
Initial care may have to be provided by the combatant.
While hemorrhage remains the number one cause of death, the second most common cause (8%) of potentially preventable deaths was upper airway obstruction due mostly to direct injury to the airway structures of the face and neck. (n = 78)
TCCC has helped U.S. combat forces to achieve the highest casualty survival rate in history.