Understanding Combat Casualty Care Statistics

## John B. Holcomb, MD, Lynn G. Stansbury, MD, Howard R. Champion, FRCS, Charles Wade, PhD, and Ronald F. Bellamy, MD

The Journal of TRAUMA, Injury, Infection, and Critical Care

J Trauma. 2006;60:397?401.

#### Description with Key Points:

The objective of this paper was to develop standardized terminology and equations that produce the best insight into the effectiveness of care at different stages of treatment. These equations were then applied consistently across data from the WWII, Vietnam and the current Global War on Terrorism (OIF/OEF). Three essential terms were clarified:

1. the Case Fatality Rate (CFR) as percentage of fatalities among all wounded
2. Killed in Action (KIA) as percentage of immediate deaths among all seriously injured (not returning to duty)
3. Died of Wounds (DOW) as percentage of deaths following admission to a medical treatment facility among all seriously injured (not returning to duty).

Using this clear set of definitions, the equations were used to ask two basic questions:

- What is the overall lethality of the battlefield?
- How effective is combat casualty care? ?

Key Chart:

## Take Home Message:

Based on a comparison of statistics for battle casualties from 1941-2005, the U.S. casualty survival rate in Iraq and Afghanistan has been the best in U.S. history.

Understanding Combat Casualty Care Statistics
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### Why Are We Doing Better?

- Improved Personal Protective Equipment

- Tactical Combat Casualty Care

- Faster evacuation time

- Better trained medics