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Combat Casualty Care

What is it?
Combat casualty care is the overarching system for providing requirements- driven and evidence-based medical solutions and products for injured Soldiers across the full spectrum of military operations. Combat casualty care encompasses prevention, pre-hospital care, acute care, evacuation, in transit, and definitive U.S.-based medical treatment facility care, as well as post-convalescent care and rehabilitation.

What has the Army done?
The Army Medical Department (AMEDD) has been instrumental in driving the evolution of combat casualty care by providing wounded Warriors with state of the art medical care from the time they are wounded through the rehabilitation process. These initiatives have been fostered by contemporary research, improved pre-deployment medical training, and the development of a military trauma system--a system that today boasts the highest survival rates of all U.S. conflicts.

The following are examples of contemporary issues addressed by the combat casualty care initiatives:

  • Damage Control Resuscitation. The concept of damage control resuscitation will be one of the lasting medical legacies of the war. It has had an unparalleled impact on the management of the most severely injured battlefield casualties, particularly those requiring massive transfusion and decreasing mortality in this circumstance from approximately 40 percent to 20 percent. The groundbreaking concept was recognized as one of the top 10 Army inventions for 2007. Studies determined that combat casualties who were administered a higher transfusion ratio of fresh frozen plasma to packed red blood cells had a higher rate of survival. Based on combat casualty care data collected in theater, a change in practice was made to employ a 1:1 transfusion ratio in patients anticipated to receive a massive transfusion. This revolutionary concept was rapidly studied, validated, and adopted in civilian trauma centers throughout the United States.
  • Hemostatic Bandages. In an effort to control post traumatic wound hemorrhage, the AMEDD has supported a vigorous effort to develop and disseminate an effective local hemostatic agent to limit bleeding in Soldiers wounded on the battlefield. The first agent—the HemCon dressing—proved to be a significant improvement over the Army field dressing. In one field analysis of 42 combat casualty cases where the Army field dressing failed to control bleeding, subsequent application of HemCon was 100 percent successful. We have continued to identify and develop more effective products to control hemorrhage. In April 2008, the Tactical Combat Casualty Care Committee recommended replacement of existing bandages with new products that provide safety, effectiveness, and tactical advantages.
  • Joint Theater Trauma System. In a coordinated effort to improve the outcomes of Soldiers injured on the battlefield, the Joint Forces have developed and implemented the Joint Theater Trauma System (JTTS) and Joint Theater Trauma Registry. The JTTS was developed using the civilian trauma system model in order to mitigate injury outcomes across the spectrum of battlefield injury. In contrast to civilian trauma systems, the majority (66.4 percent) of battlefield wounds were penetrating mechanism. In response to this complex, severely injured population, the JTTS recognized numerous trauma system issues requiring leadership, advocacy, education, research, and alterations in clinical care prompting the emplacement of 23 evidence-based clinical practice guidelines. The JTTS initiatives have improved battlefield injury survival when compared to previous conflicts. The JTTS has set the standard of trauma care for the modern battlefield and will continue to foster advances in military medicine and translation into civilian practice.
  • Traumatic Brain Injury (TBI). TBI has been described as the signature wound of the current conflict, but diagnosing and treating brain injury resulting from trauma is one of the major knowledge gaps within medicine. Biomarker assays that show promise of becoming field-deployable blood tests are currently in clinical trials. Other assays are currently under development to achieve an objective test of brain cell damage. Novel therapeutic agents have been developed that show excellent pre-clinical results in mitigating the effects of brain injury and clinical trials are being conducted to determine whether these agents are effective in victims of mild to severe traumatic brain injury.

What continued efforts does the Army have planned for the future?
The Army's combat casualty care system takes great pride in the care of our wounded Warriors and will continue to improve the outcomes of our wounded Soldiers, Sailors, Airmen, and Marines.

Why is this important to the Army?
Combat casualty care saves lives and reflects the unrelenting commitment expressed in the Warrior Ethos, "I will never leave a fallen comrade." Combat injuries typically occur in austere environments—characterized by limited medical supplies, diagnostic tools, and life-support equipment. Overcoming these limitations by providing biologics, pharmaceuticals, and devices that enhance the capability of first responders to effectively treat casualties as close as possible to the location and time of an injury is a force multiplier. When Soldiers have faith in the combat care they will receive, they tend to be more mission focused.

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