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Damage control resuscitation and surgery for indigenous combat casualties: a prospective observational study
  1. Kieran Campbell1,
  2. D N Naumann2,
  3. K Remick3 and
  4. C Wright4
  1. 1 HQ DPHC (NIWW), Venning Barracks, Donnington, Telford, UK
  2. 2 Academic Department of Military Surgery and Trauma, Birmingham, UK
  3. 3 Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA
  4. 4 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Kieran Campbell, HQ DPHC (NIWW), Venning Barracks, Donnington, Telford TF2 8AF, UK; kieran.campbell{at}


Introduction Specialist units that assist indigenous forces (IF) in their strategic aims are supported by medical teams providing point of injury emergency care for casualties, including IF and civilians (Civ). We investigated the activities of a Coalition Forces far-forward medical facility, in order to inform medical providers about the facilities and resources required for medical support to IF and Civ during such operations.

Methods A prospective observational study (June to August 2017) undertaken at a far-forward Coalition Forces medical support unit (12 rotating personnel) recorded patient details (IF or Civ), mechanism of injury (MOI), number of blood products used, damage control resuscitation (DCR) and damage control surgery (DCS), number of mass casualty (MASCAL) scenarios, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA) and whole blood emergency donor panels (EDP).

Results 680 casualties included 478 IF and 202 Civ (45.5% of the Civ were paediatric). Most common MOIs were blast (n=425; 62.5%) and gunshot wound (n=200; 29.4%). Fifteen (2.2%) casualties died; 627 (92.2%) were transferred to local hospitals. DCR was used for 203 (29.9%), and DCS for 182 (26.8%) casualties. There were 23 MASCAL scenarios, 1220 transfusions and 32 EDPs. REBOA was performed eight times, and thoracotomy was performed 27 times.

Conclusions A small medical team provided high-tempo emergency resuscitative care for hundreds of IF and Civ casualties within a short space of time using state-of-the-art resuscitative modalities. DCR and DCS were undertaken with a large number of EDPs, and a high survival-to-transfer rate.

  • trauma management
  • surgery
  • adult intensive and critical care
  • organisation of health services
  • accident and emergency medicine

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  • Contributors KC and DNN designed the study. Data collection was undertaken by KC. Data analysis and interpretation was done by DNN, KC, KR and CW. KC and DNN wrote the first draft of the manuscript. KR and CW provided critical appraisal and revisions of manuscript. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Any opinions expressed within this manuscript are the authors’ own, and do not necessarily represent those of the Coalition Forces. Some elements of the study location and personnel have been withheld in order to protect restricted details. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions or policies of the Uniformed Services University of the Health Sciences (USUHS), the Department of Defense (DoD), the Departments of the Army, Navy, or Air Force.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data sharing statement Data are available upon reasonable request.