Modeling Musculoskeletal Combat Casualty Care: NATO Trauma System Performance in Large Scale Combat Operations.

Area of Science:

• Military Medicine
• Trauma Surgery
• Health Systems Research

Background:

• The effectiveness of the North Atlantic Treaty Organization (NATO) trauma system in Large-Scale Combat Operations (LSCO) remains uncertain.
• Modeling the NATO trauma system's efficacy in LSCO is crucial for optimizing battlefield medical care.
• Novel scenarios are needed to adapt the current system for LSCO environments.

Purpose of the Study:

• To model the efficacy of the existing NATO trauma system in LSCO.
• To simulate novel scenarios for adapting the NATO trauma system to LSCO.
• To evaluate the impact of augmented systems and Field Hospital proximity on patient survival.

Main Methods:

• A discrete-event simulation model was developed for combat musculoskeletal injuries within the NATO system.
• The model incorporated health states: stable, hypovolemia, sepsis, shock, and death.
• Combat intensity was simulated by increasing casualties up to 192 per 24 hours, comparing standard, augmented (FC), and Field Hospital (FH) models.

Main Results:

• Mortality rates increased significantly with casualty volume, reaching 61% at 12 casualties/24 hours in the base model.
• The augmented Forward Care (FC) model showed no significant improvement over the base model across casualty rates.
• The Field Hospital (FH) model demonstrated significantly higher successful evacuation rates compared to the base model at multiple casualty rates (p < 0.05).

Conclusions:

• The current NATO trauma system exhibits high mortality during LSCO.
• Situating Field Hospitals within one hour of ground transport from the battlefront is the most effective modification.
• Optimizing medical evacuation and treatment proximity is critical for improving survival in large-scale combat casualties.