Tactical combat casualty and critical care-An evolving concept in casualty management in a Tertiary Care Hospital

Abstract

Introduction: The Indian Army has been in engaged in wars, counter terrorism operations and relief work during natural or manmade disasters for a long time. An observational study of 707 casualties admitted in a tertiary care hospital was conducted to analyse tactical combat casualty care in the Indian perspective and assess the survival outcomes. Method: The study included the type of casualties, their mode of evacuation, patient survival and outcome. Results: Total 707 casualties incurred 780 wounds. All of them were initially managed at peripheral Medical Inspection Room (MI Room) and then evacuated to the tertiary hospital via road/air. Total 535 casualties were transferred by air and 172 by road. Average time taken by air was 45 minutes and by road was 3 hours and 35 minutes. Road traffic accident was the greatest contributor and averaged 76.8%. Injury distribution in our study was head and neck 2.94%, chest 1.79%, abdomen 17.94%, and extremities 77.30%. 610 injuries were operated at tertiary hospital and remaining 170 were operated at peripheral hospitals. There were three hospital deaths while one patient died at peripheral hospital during resuscitation. Discussion: We reviewed the epidemiology of military trauma to identify survival patterns from which operationally appropriate treatment strategies may be developed. Due to absence of night flying, two casualties were forced to be evacuated by road. One casualty expired during evacuation due to gunshot wound of chest and exsanguination. Patients who required surgery were operated upon within five hours, thus achieving maximum survival benefit. The study highlights the constraints in tactical combat care because of unconventional nature of conflicts and hostile terrains. However, an appropriately triaged patient can be referred for more definitive management, or if possible can be air - evacuated to the tertiary care hospital directly for better survival outcomes.