Resuscitation During Critical Care Transportation in Afghanistan

Area of Science:

• Military Medicine
• Trauma Surgery
• Emergency Medicine

Background:

• Combat casualties in Afghanistan require extensive medical care during transport.
• Understanding resuscitation markers is crucial for optimizing casualty care.
• Previous data on critical care interventions during evacuation are limited.

Purpose of the Study:

• To describe critical care procedures and resuscitation markers in severely wounded personnel during transport.
• To inform the design of future critical care transportation platforms for military conflicts.

Main Methods:

• Data from the Department of Defense Trauma Registry (DoDTR) for combat casualties (ISS > 15) in Operation Enduring Freedom (2010) were analyzed.
• Both point of injury (POI) and intratheater transports were reviewed.
• Base deficit (BD) and international normalized ratio (INR) were assessed as markers of resuscitation and coagulopathy.

Main Results:

• 1198 transport events were analyzed: 634 (53%) from POI and 564 (47%) intratheater.
• Critical care interventions were performed in 12.3% of transports.
• Mean BD was -5.4 mEq/L for POI and 0.68 mEq/L for intratheater transports (p<.001).
• Mean INR was 1.48 for POI and 1.21 for intratheater transports (p<.001).

Conclusions:

• Severely injured personnel frequently require critical care interventions during evacuation.
• Initial transports from POI often result in acidosis and coagulopathy.
• A dedicated platform for damage control resuscitation is recommended for prolonged transports of critically injured patients.