A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom: The importance of evacuation timing

Nichole Ingalls, David Zonies, Jeffrey A. Bailey, Kathleen D. Martin, Bart O. Iddins, Paul K. Carlton, Dennis Hanseman, Richard Branson, Warren Dorlac, Jay Johannigman

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

IMPORTANCE Advances in the care of the injured patient are perhaps the only benefit of military conflict. One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. OBJECTIVES To identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of CCATT records and the Joint Theater Trauma Registry from September 11, 2001, to December 31, 2010, for the in-theater military medicine health system, including centers in Iraq, Afghanistan, and Germany. Of 2899 CCATT transport records, those for 975 individuals had all the required data elements. EXPOSURE Rapid evacuation by the CCATT. MAIN OUTCOMES AND MEASURES Survival as a function of time from injury to arrival at the role IV facility at Landstuhl Regional Medical Center. RESULTS The patient cohort demonstrated a mean Injury Severity Score of 23.7 and an overall 30-day mortality of 2.1%. Mortality en route was less than 0.02%. Statistically significant differences between survivors and decedents with respect to the Injury Severity Score (mean [SD], 23.4 [12.4] vs 37.7 [16.5]; P <.001), cumulative volume of blood transfused among the patients in each group who received a transfusion (P <.001), worst base deficit (mean [SD],-3.4 [5.0] vs-7.8 [6.9]; P = .02), and worst international normalized ratio (median [interquartile range], 1.2 [1.0-1.4] vs 1.4 [1.1-2.2]; P = .03) were observed.We found no statistically significant difference between survivors and decedents with respect to time from injury to arrival at definitive care. CONCLUSIONS AND RELEVANCE Rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred duringmovement and overall 30-day mortality.We found no association between the duration of time from wounding to arrival at Landstuhl Regional Medical Center with respect to mortality.

Original languageEnglish (US)
Pages (from-to)807-813
Number of pages7
JournalJAMA Surgery
Volume149
Issue number8
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

2003-2011 Iraq War
Afghan Campaign 2001-
Critical Care
Mortality
Air
Wounds and Injuries
Injury Severity Score
Survivors
Registries
Joints
Military Medicine
Afghanistan
Iraq
International Normalized Ratio
Military Personnel
Blood Volume
Germany
Patient Care

ASJC Scopus subject areas

  • Surgery

Cite this

A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom : The importance of evacuation timing. / Ingalls, Nichole; Zonies, David; Bailey, Jeffrey A.; Martin, Kathleen D.; Iddins, Bart O.; Carlton, Paul K.; Hanseman, Dennis; Branson, Richard; Dorlac, Warren; Johannigman, Jay.

In: JAMA Surgery, Vol. 149, No. 8, 2014, p. 807-813.

Research output: Contribution to journalArticle

Ingalls, N, Zonies, D, Bailey, JA, Martin, KD, Iddins, BO, Carlton, PK, Hanseman, D, Branson, R, Dorlac, W & Johannigman, J 2014, 'A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom: The importance of evacuation timing', JAMA Surgery, vol. 149, no. 8, pp. 807-813. https://doi.org/10.1001/jamasurg.2014.621
Ingalls, Nichole ; Zonies, David ; Bailey, Jeffrey A. ; Martin, Kathleen D. ; Iddins, Bart O. ; Carlton, Paul K. ; Hanseman, Dennis ; Branson, Richard ; Dorlac, Warren ; Johannigman, Jay. / A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom : The importance of evacuation timing. In: JAMA Surgery. 2014 ; Vol. 149, No. 8. pp. 807-813.
@article{5d04bec222d6496fbf823ea6df2b692b,
title = "A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom: The importance of evacuation timing",
abstract = "IMPORTANCE Advances in the care of the injured patient are perhaps the only benefit of military conflict. One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. OBJECTIVES To identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of CCATT records and the Joint Theater Trauma Registry from September 11, 2001, to December 31, 2010, for the in-theater military medicine health system, including centers in Iraq, Afghanistan, and Germany. Of 2899 CCATT transport records, those for 975 individuals had all the required data elements. EXPOSURE Rapid evacuation by the CCATT. MAIN OUTCOMES AND MEASURES Survival as a function of time from injury to arrival at the role IV facility at Landstuhl Regional Medical Center. RESULTS The patient cohort demonstrated a mean Injury Severity Score of 23.7 and an overall 30-day mortality of 2.1{\%}. Mortality en route was less than 0.02{\%}. Statistically significant differences between survivors and decedents with respect to the Injury Severity Score (mean [SD], 23.4 [12.4] vs 37.7 [16.5]; P <.001), cumulative volume of blood transfused among the patients in each group who received a transfusion (P <.001), worst base deficit (mean [SD],-3.4 [5.0] vs-7.8 [6.9]; P = .02), and worst international normalized ratio (median [interquartile range], 1.2 [1.0-1.4] vs 1.4 [1.1-2.2]; P = .03) were observed.We found no statistically significant difference between survivors and decedents with respect to time from injury to arrival at definitive care. CONCLUSIONS AND RELEVANCE Rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred duringmovement and overall 30-day mortality.We found no association between the duration of time from wounding to arrival at Landstuhl Regional Medical Center with respect to mortality.",
author = "Nichole Ingalls and David Zonies and Bailey, {Jeffrey A.} and Martin, {Kathleen D.} and Iddins, {Bart O.} and Carlton, {Paul K.} and Dennis Hanseman and Richard Branson and Warren Dorlac and Jay Johannigman",
year = "2014",
doi = "10.1001/jamasurg.2014.621",
language = "English (US)",
volume = "149",
pages = "807--813",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - A reviewof the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom

T2 - The importance of evacuation timing

AU - Ingalls, Nichole

AU - Zonies, David

AU - Bailey, Jeffrey A.

AU - Martin, Kathleen D.

AU - Iddins, Bart O.

AU - Carlton, Paul K.

AU - Hanseman, Dennis

AU - Branson, Richard

AU - Dorlac, Warren

AU - Johannigman, Jay

PY - 2014

Y1 - 2014

N2 - IMPORTANCE Advances in the care of the injured patient are perhaps the only benefit of military conflict. One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. OBJECTIVES To identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of CCATT records and the Joint Theater Trauma Registry from September 11, 2001, to December 31, 2010, for the in-theater military medicine health system, including centers in Iraq, Afghanistan, and Germany. Of 2899 CCATT transport records, those for 975 individuals had all the required data elements. EXPOSURE Rapid evacuation by the CCATT. MAIN OUTCOMES AND MEASURES Survival as a function of time from injury to arrival at the role IV facility at Landstuhl Regional Medical Center. RESULTS The patient cohort demonstrated a mean Injury Severity Score of 23.7 and an overall 30-day mortality of 2.1%. Mortality en route was less than 0.02%. Statistically significant differences between survivors and decedents with respect to the Injury Severity Score (mean [SD], 23.4 [12.4] vs 37.7 [16.5]; P <.001), cumulative volume of blood transfused among the patients in each group who received a transfusion (P <.001), worst base deficit (mean [SD],-3.4 [5.0] vs-7.8 [6.9]; P = .02), and worst international normalized ratio (median [interquartile range], 1.2 [1.0-1.4] vs 1.4 [1.1-2.2]; P = .03) were observed.We found no statistically significant difference between survivors and decedents with respect to time from injury to arrival at definitive care. CONCLUSIONS AND RELEVANCE Rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred duringmovement and overall 30-day mortality.We found no association between the duration of time from wounding to arrival at Landstuhl Regional Medical Center with respect to mortality.

AB - IMPORTANCE Advances in the care of the injured patient are perhaps the only benefit of military conflict. One of the unique aspects of the military medical care system that emerged during Operation Iraqi Freedom and Operation Enduring Freedom has been the opportunity to apply existing civilian trauma system standards to the provision of combat casualty care across an evolving theater of operations. OBJECTIVES To identify differences in mortality for soldiers undergoing early and rapid evacuation from the combat theater and to evaluate the capabilities of the Critical Care Air Transport Team (CCATT) and Joint Theater Trauma Registry databases to provide adequate data to support future initiatives for improvement of performance. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of CCATT records and the Joint Theater Trauma Registry from September 11, 2001, to December 31, 2010, for the in-theater military medicine health system, including centers in Iraq, Afghanistan, and Germany. Of 2899 CCATT transport records, those for 975 individuals had all the required data elements. EXPOSURE Rapid evacuation by the CCATT. MAIN OUTCOMES AND MEASURES Survival as a function of time from injury to arrival at the role IV facility at Landstuhl Regional Medical Center. RESULTS The patient cohort demonstrated a mean Injury Severity Score of 23.7 and an overall 30-day mortality of 2.1%. Mortality en route was less than 0.02%. Statistically significant differences between survivors and decedents with respect to the Injury Severity Score (mean [SD], 23.4 [12.4] vs 37.7 [16.5]; P <.001), cumulative volume of blood transfused among the patients in each group who received a transfusion (P <.001), worst base deficit (mean [SD],-3.4 [5.0] vs-7.8 [6.9]; P = .02), and worst international normalized ratio (median [interquartile range], 1.2 [1.0-1.4] vs 1.4 [1.1-2.2]; P = .03) were observed.We found no statistically significant difference between survivors and decedents with respect to time from injury to arrival at definitive care. CONCLUSIONS AND RELEVANCE Rapid movement of critically injured casualties within hours of wounding appears to be effective, with a minimal mortality incurred duringmovement and overall 30-day mortality.We found no association between the duration of time from wounding to arrival at Landstuhl Regional Medical Center with respect to mortality.

UR - http://www.scopus.com/inward/record.url?scp=84906656919&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906656919&partnerID=8YFLogxK

U2 - 10.1001/jamasurg.2014.621

DO - 10.1001/jamasurg.2014.621

M3 - Article

C2 - 25074327

AN - SCOPUS:84906656919

VL - 149

SP - 807

EP - 813

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 8

ER -