Saving Lives on the Battlefield: A Joint Trauma System Review of Pre-Hospital Trauma Care in Combined Joint Operating Area - Afghanistan (CJOA-A)

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Abstract : During the Vietnam conflict, many U.S. casualties died because they failed to receive pre-hospital trauma care interventions as simple as placing a tourniquet on a bleeding extremity. A paper from the Vietnam era noted that: ...little if any improvement has been made in this (pre-hospital) phase of treatment of combat wounds in the past 100 years. This statement continued to be true until the development of Tactical Combat Casualty Care (TCCC) in 1996. TCCC is a set of pre-hospital trauma care guidelines customized for use on the battlefield. One example of the lifesaving potential of TCCC guidelines is renewed focus on pre-hospital tourniquet use. Until recently military medics were taught that a tourniquet should be used only as a last resort to control extremity hemorrhage, yet a study of 2600 combat fatalities incurred during the Vietnam conflict and a study of 982 combat fatalities incurred during the early years of conflict in Afghanistan and Iraq noted death from extremity hemorrhage was relatively unchanged at 7.4% and 7.8% respectively. After the global implementation of the tourniquet recommendations from the TCCC guidelines, a recent comprehensive study of 4596 U.S. combat fatalities from 2001 to 2011 noted that only 2.6% of total combat fatalities resulted from extremity hemorrhage. This dramatic decrease in deaths from extremity hemorrhage resulted from ubiquitous fielding of modern tourniquets and aggressive training of all potential first responders on tourniquet application. Currently, if you are a U.S. or Coalition casualty on the battlefield of Afghanistan and you arrive alive to a Role 3 Medical Treatment Facility (MTF), your chance of survival is greater than 98%. Although the overall case fatality rate in the ongoing conflict is lower in comparison to previous conflicts, significant challenges still remain.