title: Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations.
abstract: BACKGROUND
  Humanitarian medical care is an essential task of the deployed military health care system. The purpose of this study was to analyze referral acceptance in treating injured local national patients during Operation Enduring Freedom.
  
  
  METHODS
  A prospective observation study of local nationals who were referred for humanitarian trauma care in Afghanistan from March through August 2009.
  
  
  RESULTS
  Sixty-six patients were referred for evacuation for suspected non-coalition-caused injuries. The bed status at the receiving hospital was defined as green (able to accept patients), amber (nearing capacity), and red (at capacity). The only factor associated with acceptance was the accepting hospital bed status (odds ratio = 1.57%, 95% confidence interval, 1.11-2.22; P = .009). Factors not significant were age, the province of origin, the type of referring facility, a prior operation before the request, patient status/affiliation, or the mechanism of injury.
  
  
  CONCLUSIONS
  Humanitarian medical care is directly related to the capacity for high-acuity care because bed availability is the predominate reason for acceptance or rejection.
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
authors.forename: Marlin
authors.initials: M
authors.lastname: Causey
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA. Electronic address: robert.rush1@us.army.mil.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rush
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Kjorstad
authors.affiliation: Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Sebesta
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000533:Altruism; D006772:Hospitals, Military; D006801:Humans; D008887:Military Medicine / Q000592:standards*; D008889:Military Personnel; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D014481:United States; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult