title: Causes of death in Canadian Forces members deployed to Afghanistan and implications on tactical combat casualty care provision.
abstract: BACKGROUND
  As part of its contribution to the Global War on Terror and North Atlantic Treaty Organization's International Security Assistance Force, the Canadian Forces deployed to Kandahar, Afghanistan, in 2006. We have studied the causes of deaths sustained by the Canadian Forces during the first 28 months of this mission. The purpose of this study was to identify potential areas for improving battlefield trauma care.
  
  
  METHODS
  We analyzed autopsy reports of Canadian soldiers killed in Afghanistan between January 2006 and April 2008. Demographic characteristics, injury data, location of death within the chain of evacuation, and cause of death were determined. We also determined whether the death was potentially preventable using both explicit review and implicit review by a panel of trauma surgeons.
  
  
  RESULTS
  During the study period, 73 Canadian Forces members died in Afghanistan. Their mean age was 29 (+/-7) years and 98% were male. The predominant mechanism of injury was explosive blast, resulting in 81% of overall deaths during the study period. Gunshot wounds and nonblast-related motor vehicle collisions were the second and third leading mechanisms of injury causing death. The mean Injury Severity Score was 57 (+/-24) for the 63 study patients analyzed. The most common cause of death was hemorrhage (38%), followed by neurologic injury (33%) and blast injuries (16%). Three deaths were deemed potentially preventable on explicit review, but implicit review only categorized two deaths as being potentially preventable.
  
  
  CONCLUSIONS
  The majority of combat-related deaths occurred in the field (92%). Very few deaths were potentially preventable with current Tactical Combat Casualty interventions. Our panel review identified several interventions that are not currently part of Tactical Combat Casualty that may prevent future battlefield deaths.
authors.affiliation: 2 Field Ambulance, Canadian Forces Base Petawawa, Petawawa, Ontario, Canada.
authors.forename: Dylan
authors.initials: D
authors.lastname: Pannell
authors.forename: Ronald
authors.initials: R
authors.lastname: Brisebois
authors.forename: Max
authors.initials: M
authors.lastname: Talbot
authors.forename: Vincent
authors.initials: V
authors.lastname: Trottier
authors.forename: Julien
authors.initials: J
authors.lastname: Clement
authors.forename: Naisan
authors.initials: N
authors.lastname: Garraway
authors.forename: Vivian
authors.initials: V
authors.lastname: McAlister
authors.forename: Homer C
authors.initials: HC
authors.lastname: Tien
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008887:Military Medicine / Q000458:organization & administration*; D008889:Military Personnel; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy