Optimizing aeromedical evacuation in combat: Balancing trauma system efficiency and patient outcomes.

Area of Science:

• Military Medicine
• Trauma Surgery
• Emergency Medicine

Background:

• The Israel Defense Forces Medical Corps (IDF-MC) employs an echelon-based system for evacuating combat casualties to civilian trauma centers.
• During large-scale conflicts, aeromedical evacuation directs urgent casualties to either frontline-adjacent medical centers (FLAMCs) or default medical centers (DMCs) to prevent FLAMC overload.
• This study evaluates the impact of casualty distribution strategies on mortality outcomes.

Purpose of the Study:

• To assess the effect of aeromedical evacuation distribution on mortality outcomes in combat casualties during the "Swords of Iron" war.
• To compare mortality rates between casualties evacuated to FLAMCs versus DMCs.

Main Methods:

• Retrospective cohort study of helicopter-evacuated IDF combat casualties from October 27, 2023, to January 19, 2025.
• Data linkage between the IDF Trauma Registry and the Israel National Trauma Registry for prehospital and in-hospital records.
• Inclusion of urgent casualties (danger to life or limb) with signs of life, using multivariable logistic regression to analyze 24-hour and 30-day mortality in severely injured patients (ISS ≥16).

Main Results:

• Of 1,443 included casualties, 67% were routed to DMCs and 33% to FLAMCs.
• Evacuation to DMCs was associated with significantly lower 24-hour (OR: 0.27) and 30-day (OR: 0.40) mortality rates.
• Casualties evacuated to FLAMCs experienced higher rates of prehospital shock and en route blood product administration.

Conclusions:

• The aeromedical evacuation policy effectively balanced casualty distribution during multiarena conflict.
• This strategy prevented the overwhelming of frontline medical facilities without negatively impacting patient outcomes.
• The findings support the current policy for managing high volumes of combat casualties in complex conflict scenarios.