Injury survivability and death preventability during recent conflicts in French combat fatalities: A retrospective...

Understanding combat mortality is vital to improving patient outcomes. We investigated injury survivability and death preventability in French combat fatalities.

This retrospective study included all French combat fatalities in overseas operations between 2008 and 2023. For each combat fatality, we assessed the survivability of their injuries and the preventability of their death. A case review was conducted to identify opportunities for improvement.

Among the 123 patients included, 74.7% were classified as killed in action. The case fatality rate decreased from 17.4% to 13.1% ( p = 0.48). The overall population sustained a median of three severe injuries (2.0-4.0), with the head-neck region being the primary involved injury (38.9%). Nonsurvivable injuries comprised 66.7% of the entire cohort; potentially survivable injuries, 30.9% of the cohort; and survivable injuries, 2.4% of the cohort. Nonpreventable death represented 73.9% of the population, and potentially preventable death represented 26.1% of the population, whereas none died from preventable death. Fatalities from Sahelian operations sustained more explosion-related injuries (47.7% vs. 29.9%), resulting in more catastrophic tissue destruction (36.4% vs. 14.9%) without significant differences in death preventability. Median evacuation time was higher for the Sahel died of wounds group (130.0 [35.0-180.0] vs. 65.0 [43.8-111.8] minutes), and half of fatalities with (potentially) survivable injuries did not survive to the "Golden Hour." Among died of wounds group with (potentially) survivable injuries at Role 2, noncompressible torso hemorrhage was the mechanism of death in 57.1% of fatalities and junctional hemorrhage in 14.2% of fatalities. Opportunities for improvement were mainly focused on the prehospital setting (85.7%).

Most combat fatalities were classified as killed in action and had nonpreventable death, while potentially preventable deaths were mainly caused by noncompressible truncal hemorrhage. Opportunities for improvement findings and real-time mortality reviews should drive training courses and further research to have the greatest impact on survival.

Prognostic and Epidemiological; Level IV.