Article Text

Download PDFPDF
Recommended medical and non-medical factors to assess military preventable deaths: subject matter experts provide valuable insights
  1. Whitney Y Harrison1,
  2. J L Wardian2,
  3. J A Sosnov3,
  4. R S Kotwal1,
  5. F K Butler1,
  6. Z T Stockinger1,
  7. S A Shackelford1,
  8. J M Gurney1,
  9. M A Spott1,
  10. L N Finelli4,
  11. E L Mazuchowski1,4,
  12. D J Smith5 and
  13. J C Janak1
  1. 1 Joint Trauma System, San Antonio, Texas, USA
  2. 2 Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, USA
  3. 3 Clinical Medicine, 375 MDOS, Scott AFB, Illinois, USA
  4. 4 Armed Forces Medical Examiner System, Dover, Delaware, USA
  5. 5 Health Affairs, Falls Church, Virginia, USA
  1. Correspondence to Whitney Y Harrison, Joint Trauma System, JBSA Ft. Sam Houston, Texas 78234, USA; whitney.y.harrison2.ctr{at}


Introduction Historically, there has been variability in the methods for determining preventable death within the US Department of Defense. Differences in methodologies partially explain variable preventable death rates ranging from 3% to 51%. The lack of standard review process likely misses opportunities for improvement in combat casualty care. This project identified recommended medical and non-medical factors necessary to (1) establish a comprehensive preventable death review process and (2) identify opportunities for improvement throughout the entire continuum of care.

Methods This qualitative study used a modified rapid assessment process that includes the following steps: (1) identification and recruitment of US government subject matter experts (SMEs); (2) multiple cycles of data collection via key informant interviews and focus groups; (3) consolidation of information collected in these interviews; and (4) iterative analysis of data collected from interviews into common themes. Common themes identified from SME feedback were grouped into the following subject areas: (1) prehospital, (2) in-hospital and (3) forensic pathology.

Results Medical recommendations for military preventable death reviews included the development, training, documentation, collection, analysis and reporting of the implementation of the Tactical Combat Casualty Care Guidelines, Joint Trauma System Clinical Practice Guidelines and National Association of Medical Examiners autopsy standards. Non-medical recommendations included training, improved documentation, data collection and analysis of non-medical factors needed to understand how these factors impact optimal medical care.

Conclusions In the operational environment, medical care must be considered in the context of non-medical factors. For a comprehensive preventable death review process to be sustainable in the military health system, the process must be based on an appropriate conceptual framework implemented consistently across all military services.

  • epidemiology
  • qualitative research
  • public health

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors contributed significantly to the study design, data collection and management, analysis, drafting and finalisation of the manuscript.

  • Funding WYH was partially funded by the Southwest Center for Occupational and Environmental Health (SWCOEH), a National Institute for Occupational Safety and Health (NIOSH) Education and Research Center at The University of Texas Health Science Center at Houston School of Public Health, and awardee of grant no 5T42OH008421 from the (NIOSH)/Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval US Army Institute of Surgical Research Institutional Review Board.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available upon reasonable request.