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Aeromedical Evacuations from Operation Iraqi Freedom: A Descriptive Study

Military Medicine, Jun 2005 by Harman, Dale R, Hooper, Tomoko I, Gackstetter, Gary D

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More than one-half of those evacuated from the OIF theater were between 18 and 29 years of age, and we would expect the distribution of battle injuries to be higher in this age group due to their combat roles. Correspondingly, we expect a larger proportion of individuals in the older age groups to require evacuation for diseases and nonbattle injuries. In fact, this is what we found (Fig. 4).

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The observed pattern in the number of aeromedical evacuations by quarter in 2003 is consistent with operational tempo. The pre-war buildup of troops and supplies for OIF began in late December 2002, and the period from March 19 to late April 2003 defined the major combat phase of OIF. As expected, the dramatic increase in the number of aeromedical evacuations during the second quarter of 2003 coincided with major combat operations and is reflected in the spike in battle-related injuries seen in Figure 3. One possible explanation for the July peak in other than combat-related evacuations is continued troop buildup. The decline in numbers of aeromedical evacuations during the remainder of 2003 may be explained by fewer combat casualties during the later portion of the year, declining rates of noncombat-related illnesses and injuries as service members adjusted to the environment, and/or improved local medical capabilities obviating the need for some evacuations.

Considering that OIF is a major armed conflict, it is remarkable that so few patients required urgent transport. The vast majority of evacuations were considered routine, defined as requiring transport within 72 hours. The high quality of medical care provided to patients in theater likely contributed to this finding. Once critically injured or ill patients are stabilized, they no longer require urgent evacuation. The realities of war also dictate that some patients who are critically ill or injured do not survive long enough to allow movement from the theater.

It is important to note that this data set does not account for all injuries and illnesses sustained by 0IF deployed forces. Movement to a level I treatment facility uses vehicles attached to the military units which do not have medical capabilities beyond buddy aid. Transport to a level II facility (where medical care is physician-directed and includes resuscitative care) generally uses Service-specific ambulances, ships, and aircraft. TRAC^sup 2^ES is used when transporting patients to level III (fixed inpatient) facilities and beyond. Other medical transportation means may have been used before the patient's entry into TRAC^sup 2^ES, and those patients not requiring transport to a level HI facility are not accounted for in our study.

Understandably, only the most vital information required for purposes of patient transport was consistently entered into the TRAC^sup 2^ES database. Therefore, we found a substantial number of fields with missing data. For example, in our data set, 15.6% of the data for gender and 4.8% for age were initially missing and had to be abstracted from free text fields before analysis. Additionally, 1.7% of the initial 28,404 lines of data had to be excluded from the data set because of invalid or incomplete social security numbers. Since the military status or nationality of these patients could not be verified, information on these patients was lost to analysis. Ensuring completion of a minimum number of specific data fields at the point of origin would be optimal. As an absolute minimum, the system should require a unique patient identifier that can subsequently be used to capture missing information from other data sources. This would also allow data linking with health and personnel data for epidemiological studies. Future technological advances may at some point allow automated data entry and tracking of patient transport in a manner similar to that currently used by global shipping companies.

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Aeromedical Evacuations from Operation Iraqi Freedom: A Descriptive Study

Military Medicine, Jun 2005 by Harman, Dale R, Hooper, Tomoko I, Gackstetter, Gary D

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