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Abstract

Introduction: US Air Force Critical Care Air Transport Teams (CCATTs) are a unique component of the military medical evacuation system. An understanding of the epidemiology of contemporary warfare is essential for pre-deployment training and optimal outcomes for critically injured warriors. We performed an epidemiological analysis of military patients transported by CCATTs during a discrete period of time. Hypothesis: The epidemiology of contemporary wartime casualties requiring critical care air transport contrasts with the characteristcs of patients seen in previous conventional conflicts. Methods: The primary source of data was the US Transportation Command (TRANSCOM) Regulating and Command and Control (C2) Evacuation System (TRAC2ES). Secondary sources were reviewed and abstracted to compare injury patterns. Descriptive statistics were used to describe the cohort. Results: Final analysis of 2011 TRAC2ES data included 396 CCATT patient transports, representing 290 patients after duplicate transports were removed. The median age was 25 years (IQR, 22 to 33). The majority of transports were male (97.6 %). The most common ICD-9-CM diagnosis was bilateral lower extremity amputation (40%). Nineteen cases of acute coronary syndromes were reported (6.6%). Nine patients with stroke were transported (3.1%). Forty-six cases of traumatic brain injury were reported (15.9%), although reporting for this injury was inconsistent. Only two patients (0.7%) had a primary diagnosis of burns. 125 subjects were injured as the result of an improvised explosive device (IED) explosion (43%), of which 87 (66%) occurred while patients were dismounted from vehicles. In 2011, more non-battle related injuries and illnesses were reported, as compared to historic data from 2001-06. Conclusions: The epidemiology of patients transported by CCATT has changed with contemporary warfare. Amputations and IED injuries were more prevalent in 2011. A higher prevalence of non-battle related injuries and explosion-related injuries may be expected in similar future conflicts. Studies of CCATT epidemiology will help focus training programs and direct evidence-based practices aimed at improving both survival and morbidity for the most severely injured casualties.