J Trauma
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US military burn casualties are evacuated to the US Army Institute of Surgical Research Burn Center in San Antonio, TX. Patients are transported by US Army Institute of Surgical Research Burn Flight Teams, Air Force Critical Care Air Transport Teams, or routine aeromedical evacuation. This study characterizes the military burn casualties transported by each team and reports associated outcomes. ⋯ Burn casualties represent a group of patients with severe traumatic injuries. Our current system of selectively using specialty medical transport teams for the long-range transport of burn casualties is safe and effective.
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Up to 9% of casualties killed in action during the Vietnam War died from exsanguination from extremity injuries. Retrospective reviews of prehospital tourniquet use in World War II and by the Israeli Defense Forces revealed improvements in extremity hemorrhage control and very few adverse limb outcomes when tourniquet times are less than 6 hours. ⋯ Prehospital tourniquet use was associated with improved hemorrhage control, particularly in the worse injured (Injury Severity Score >15) subset of patients. Fifty-seven percent of the deaths might have been prevented by earlier tourniquet use. There were no early adverse outcomes related to tourniquet use.
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Although sustaining physical injury in theater increases service members' risk for posttraumatic stress disorder (PTSD), exposure to explosive munitions may increase the risk of mild traumatic brain injury (mTBI). We hypothesized a higher incidence of PTSD and mTBI in service members who sustained both burn and explosion injuries than in nonexplosion exposed service members. ⋯ Given the high incidence of these disorders in burned service members, further screening of PTSD and TBI appears warranted. Because symptom presentation in PTSD and mTBI is clinically similar in acute and subacute stages, and treatments can vary widely, further research investigating symptom profiles of PTSD and mTBI is warranted.
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The opinion that injuries sustained in Iraq and Afghanistan have increased in severity is widely held by clinicians who have deployed multiple times. To continuously improve combat casualty care, the Department of Defense has enacted numerous evidence-based policies and clinical practice guidelines. We hypothesized that the severity of wounds has increased over time. Furthermore, we examined cause of death looking for opportunities of improvement for research and training. ⋯ In the time periods of the war studied, deaths per month has doubled, with increases in both injury severity and number of wounds per casualty. Truncal hemorrhage is the leading cause of potentially survivable deaths. Arguably, the success of the medical improvements during this war has served to maintain the lowest case fatality rate on record.