US military medical evacuation and prehospital care of pediatric trauma casualties in Iraq and Afghanistan
JasonF. Naylor , DSc PA-C, Michael D. April , MD PhD MS, Erick E. Thronson , BSN, Guyon J. Hill , MD & Steven G. Schauer , DO MS
Received 15 Feb 2019, Accepted 29 May 2019, Accepted author version posted online: 03 Jun 2019
Download citation https://doi.org/10.1080/10903127.2019.1626956
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ABSTRACT
Background: Traumatic injuries were the most common reason for pediatric admission to military hospitals during the recent wars in the Middle East. We describe injury characteristics and prehospital interventions performed on wartime pediatric trauma casualties in Afghanistan and Iraq, stratified by medical evacuation platform.
Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (age <18 years) encounters from January 2007 to January 2016. The DODTR is the data repository for all trauma-related injuries managed by deployed US military medical treatment facilities with surgical capabilities. We requested all documented prehospital care, which may have been delivered anywhere from the point-of-injury until a fixed-facility with surgical capabilities. We stratified subjects according to Centers for Disease Control age groupings: <1 year, 1-4 years, 5-9 years, 10-14 years, and 15-17 years.
Results: Of the 3,493 pediatric encounters in the DODTR, 1,004 underwent military evacuation from the point of injury – 911 (90.7%) by standard medical evacuation platforms and 93 (9.3%) by non-standard, improvised evacuation assets. Six hundred seventy-five of the 1004 pediatric trauma casualties were between 5-14 years of age. Over 75% were male, over 80% were in Afghanistan, and most were injured by explosives. Across all age groups, serious injuries to the head/neck and extremities were most common. Subjects transported by standard evacuation platforms underwent tourniquet application (12.2% vs 5.3%, p < 0.05) and intraosseous access (12.2% vs 4.3%; p = 0.02) more frequently than those on non-standard platforms. Casualties evacuated by non-standard platforms underwent airway adjunct emplacement more frequently those on standard evacuation assets (3.2% vs 0.3%; p = 0.01). IV access and opiate administration were the most commonly performed interventions on both standard and non-standard assets. Subject survival to hospital discharge was 88.1% on standard platforms and 89.2% on non-standard platforms (p = 0.75).
Conclusions: Approximately 30% of pediatric trauma casualties in Afghanistan and Iraq underwent medical evacuation from the point of injury directly to a military treatment facility with surgical capabilities. Most of those children did not undergo the prehospital interventions studied. Future investigations evaluating pediatric medical evacuation and prehospital care, medical staffing, pediatric-specific training, and equipping of pediatric-specific materials may be beneficial.
Keywords: Pediatric, prehospital, trauma, evacuation, combat
JasonF. Naylor , DSc PA-C, Michael D. April , MD PhD MS, Erick E. Thronson , BSN, Guyon J. Hill , MD & Steven G. Schauer , DO MS
Received 15 Feb 2019, Accepted 29 May 2019, Accepted author version posted online: 03 Jun 2019
Download citation https://doi.org/10.1080/10903127.2019.1626956
Select Language▼
Translator disclaimer
Full Article Figures & data References Citations Metrics Reprints & Permissions Get access
Accepted author version
ABSTRACT
Background: Traumatic injuries were the most common reason for pediatric admission to military hospitals during the recent wars in the Middle East. We describe injury characteristics and prehospital interventions performed on wartime pediatric trauma casualties in Afghanistan and Iraq, stratified by medical evacuation platform.
Methods: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric (age <18 years) encounters from January 2007 to January 2016. The DODTR is the data repository for all trauma-related injuries managed by deployed US military medical treatment facilities with surgical capabilities. We requested all documented prehospital care, which may have been delivered anywhere from the point-of-injury until a fixed-facility with surgical capabilities. We stratified subjects according to Centers for Disease Control age groupings: <1 year, 1-4 years, 5-9 years, 10-14 years, and 15-17 years.
Results: Of the 3,493 pediatric encounters in the DODTR, 1,004 underwent military evacuation from the point of injury – 911 (90.7%) by standard medical evacuation platforms and 93 (9.3%) by non-standard, improvised evacuation assets. Six hundred seventy-five of the 1004 pediatric trauma casualties were between 5-14 years of age. Over 75% were male, over 80% were in Afghanistan, and most were injured by explosives. Across all age groups, serious injuries to the head/neck and extremities were most common. Subjects transported by standard evacuation platforms underwent tourniquet application (12.2% vs 5.3%, p < 0.05) and intraosseous access (12.2% vs 4.3%; p = 0.02) more frequently than those on non-standard platforms. Casualties evacuated by non-standard platforms underwent airway adjunct emplacement more frequently those on standard evacuation assets (3.2% vs 0.3%; p = 0.01). IV access and opiate administration were the most commonly performed interventions on both standard and non-standard assets. Subject survival to hospital discharge was 88.1% on standard platforms and 89.2% on non-standard platforms (p = 0.75).
Conclusions: Approximately 30% of pediatric trauma casualties in Afghanistan and Iraq underwent medical evacuation from the point of injury directly to a military treatment facility with surgical capabilities. Most of those children did not undergo the prehospital interventions studied. Future investigations evaluating pediatric medical evacuation and prehospital care, medical staffing, pediatric-specific training, and equipping of pediatric-specific materials may be beneficial.
Keywords: Pediatric, prehospital, trauma, evacuation, combat
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