title: Analysis of life-saving interventions performed by out-of-hospital combat medical personnel.
abstract: BACKGROUND
  To analyze casualties from the Camp Eagle Study, focusing on life-saving interventions (LSI) and potentially survivable deaths.
  
  
  METHODS
  Retrospective cohort of battle casualties from a forward base engaged in urban combat in Central Iraq. Medical support included emergency medicine practitioners and combat medics with advanced training and protocols. LSI were defined as advanced airway, needle or tube thoracostomy, tourniquet, and hypotensive resuscitation with Hetastarch. Cases were assessed retrospectively for notional application of a Remote Damage Control Resuscitation protocol using blood products.
  
  
  RESULTS
  Three hundred eighteen subjects were included. The case fatality rate was 7%. "Urgent" (55) or "priority" (88) medical evacuation was required for 45% of casualties. Sixty-one LSI were performed, in most cases by the physician or PA, with 80% on "urgent" and 9% on "priority" casualties, respectively. Among survivors requiring LSI, the percentage actually performed were airway 100%; thoracostomy 100%; tourniquet 100%; hetastarch 100%. Among nonsurvivors, these percentages were 78%, 50%, 100%, and 56%, respectively. Proximate causes of potentially survivable death were delays in airway placement and ventilation (40%), no thoracostomy (20%), and delayed evacuation resulting in hemorrhagic shock (60%). The notional Remote Damage Control Resuscitation protocol would have been appropriate in 15% of "urgent" survivors and in 26% of nonsurvivors.
  
  
  CONCLUSIONS
  LSI were required by most urgent casualties, and a lack or delay in their performance was associated with increased mortality. Forward deployment of blood components may represent the next addition to LSI if logistical and scope-of-practice issues can be overcome.
authors.affiliation: US Army Institute of Surgical Research, the Department of Emergency, Brooke Army Medical Center, Fort Sam, Houston, Texas 78234, USA. robert.gerhardt@amedd.army.mil
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.forename: Johnathon A
authors.initials: JA
authors.lastname: Berry
authors.forename: Lorne H
authors.initials: LH
authors.lastname: Blackbourne
mesh_terms: D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008887:Military Medicine / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013907:Thoracostomy / Q000706:statistics & numerical data; D014111:Tourniquets / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*