title: Augmentation of point of injury care: Reducing battlefield mortality-The IDF experience.
abstract: OBJECTIVE
  In 2012, the Israel Defense Forces Medical Corps (IDF-MC) set a goal of reducing mortality and eliminating preventable death on the battlefield. A force buildup plan entitled "My Brother's Keeper" was launched addressing: trauma medicine, training, change of Clinical Practice Guidelines (CPGs), injury prevention, data collection, global collaboration and more. The aim of this article is to examine how military medical care has evolved due "My Brother's Keeper" between Second Lebanon War (SLW, 2006) to Operation Protective Edge (OPE, 2014).
  
  
  METHODS
  Records of all casualties during OPE and SLW were extracted and analyzed from the I.D.F Trauma Registry. Noncombat injuries and civilian injuries from missile attacks were excluded from this analysis.
  
  
  RESULTS
  The plans main impacts were; incorporation of a physician or paramedic as an integral part of each fighting company, implementation of new CPGs, introduction of new approaches for extremity haemorrhage control and Remote Damage Control Resuscitation at point of injury (POI) using single donor reconstituted freeze dried plasma (25 casualties) and transexamic acid (98 casualties). During OPE, 704 soldiers sustained injuries compared with 833 casualties during SLW. Fatalities were 65 and 119, respectively, cumulating to Case Fatality Rate of 9.2% and 14.3%, respectively.
  
  
  CONCLUSIONS
  Significant changes in the way the IDF-MC provides combat casualty care have been made in recent years. It is the transformation from concept to doctrine and integration into a structured and Goal-Oriented Casualty Care System, especially POI care that led to the unprecedented survival rates in IDF as shown in this conflict.
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel; USA Institute of Surgical Research, JBSA, Fort Sam Houston, TX, USA. Electronic address: avi.benov@gmail.com.
authors.lastname: Benov Avi
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Glassberg
authors.initials: G
authors.lastname: Elon
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Erez Nissim
authors.initials: EN
authors.lastname: Baruch
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Shina
authors.initials: S
authors.lastname: Avi
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Twig
authors.initials: T
authors.lastname: Gilad
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Levi
authors.initials: L
authors.lastname: Moran
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Zoarets
authors.initials: Z
authors.lastname: Itay
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Sagi
authors.initials: S
authors.lastname: Ram
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Bader
authors.initials: B
authors.lastname: Tarif
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Dagan
authors.initials: D
authors.lastname: David
authors.affiliation: Israel Defense Forces' Medical Corps, Ramat Gan, Israel.
authors.forename: Yitzhak
authors.initials: Y
authors.lastname: Avraham
authors.affiliation: Department of Military Medicine, Hebrew University, Jerusalem, Israel; Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Kreiss
authors.initials: K
authors.lastname: Yitshak
mesh_terms: D002959:Civil Defense / Q000458:organization & administration; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D007557:Israel; D008297:Male; D054527:Mass Casualty Incidents / Q000401:mortality; D008887:Military Medicine / Q000379:methods / Q000458:organization & administration; D008889:Military Personnel; D019095:Point-of-Care Systems / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D014857:Warfare; D014947:Wounds and Injuries / Q000401:mortality / Q000628:therapy*; D055815:Young Adult
keywords: Mortality; My Brother's Keeper; Preventable death; Trauma