Trauma care at a multinational United Kingdom-led Role 3 combat hospital: resuscitation outcomes from a multidisciplinary approach.
Recent conflicts have led significant advancements in casualty care. Facilities serving combat wounded operate in challenging environments. Our purpose is to describe the multidisciplinary resuscitation algorithm utilized at a United Kingdom-led, Role 3 multinational treatment facility in Afghanistan focusing on injury severity and in-hospital mortality.


METHODS
Data were extracted from our prospectively collected trauma registry on military members wounded in action.


RESULTS
From November 1, 2009 to September 30, 2011, there were 3483 military trauma admissions. Common mechanisms of injury were improvised explosive devices (48%), followed by gunshot wounds (29%). Most patients (83.1%) had an Injury Severity Score (ISS) <15. For patients with complete ISS data, 8.4% had massive transfusion and 6.1% had an initial base deficit >5. Patients admitted with signs of life had a died of wounds rate of 1.8% with an average 1.2 day hospital stay. The mortality rate for patients undergoing massive transfusion was 4.8%, and for patients with a base deficit >5, mortality was 12.3%. Severely injured patients (ISS > 24) had a mortality rate of 16.5%.


CONCLUSIONS
A systematic, multidisciplinary approach to trauma is associated with low in-hospital mortality. The outcomes in this study serve as a measure for future care in Role 3 facilities.
Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234.
Creighton C
CC
Tubb
Department of Surgery, Walter Reed National Military Medical Center, 2901 Wisconsin Avenue, Bethesda, MD 20889.
John S
JS
Oh
Clinical Capability Management, Room 4SW327, 7700 Arlington Boulevard, Falls Church, VA 22042-5101.
Nhan V
NV
Do
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Birmingham, B15 2SQ, United Kingdom.
Nigel R
NR
Tai
Institute of Surgical Research, Building 3611, 3698 Chambers Pass, Fort Sam Houston, TX 78234.
Michael P
MP
Meissel
The Eisenhower School, National Defense University, 117 South Aberdeen Street, Arlington, VA 22204.
Michael L
ML
Place
D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001803:Blood Transfusion / Q000706:statistics & numerical data; D054042:Bombs; D017052:Hospital Mortality; D006772:Hospitals, Military / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D038622:Internationality; D007902:Length of Stay / Q000706:statistics & numerical data; D008889:Military Personnel / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team; D011446:Prospective Studies; D012042:Registries; D012151:Resuscitation / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D006113:United Kingdom; D000067398:War-Related Injuries / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000453:epidemiology; D055815:Young Adult