RT Journal Article
SR Electronic
T1 Died of wounds: a mortality review
JF Journal of the Royal Army Medical Corps
JO J R Army Med Corps
FD British Medical Journal Publishing Group
SP 355
OP 360
DO 10.1136/jramc-2015-000490
VO 162
IS 5
A1 Damian Douglas Keene
A1 JG Penn-Barwell
A1 PR Wood
A1 N Hunt
A1 R Delaney
A1 J Clasper
A1 RJ Russell
A1 PF Mahoney
YR 2016
UL http://militaryhealth.bmj.com/content/162/5/355.abstract
AB Objectives Combat casualty care is a complex system involving multiple clinicians, medical interventions and casualty transfers. Improving the performance of this system requires examination of potential weaknesses. This study reviewed the cause and timing of death of casualties deemed to have died from their injuries after arriving at a medical treatment facility during the recent conflicts in Iraq and Afghanistan, in order to identify potential areas for improving outcomes.Methods This was a retrospective review of all casualties who reached medical treatment facilities alive, but subsequently died from injuries sustained during combat operations in Afghanistan and Iraq. It included all deaths from start to completion of combat operations. The UK military joint theatre trauma registry was used to identify cases, and further data were collected from clinical notes, postmortem records and coroner's reports.Results There were 71 combat-related fatalities who survived to a medical treatment facility; 17 (24%) in Iraq and 54 (76%) in Afghanistan. Thirty eight (54%) died within the first 24 h. Thirty-three (47%) casualties died from isolated head injuries, a further 13 (18%) had unsurvivable head injuries but not in isolation. Haemorrhage following severe lower limb trauma, often in conjunction with abdominal and pelvic injuries, was the cause of a further 15 (21%) deaths.Conclusions Severe head injury was the most common cause of death. Irrespective of available medical treatment, none of this group had salvageable injuries. Future emphasis should be placed in preventative strategies to protect the head against battlefield trauma.