Cutting Transport Time and Enhancing Pre-Hospital Care Saved Hundreds

Sept 30, 2015 JAMA articleIn the September 30, 2015 online edition of JAMA Surgery, Russ S. Kotwal, MD, et al. review the effect of a 2009 policy change on the morbidity and mortality of combat casualties in the wars in Iraq and Afghanistan. Then Secretary of Defense, Robert Gates, issued a mandate to reduce transport time from battlefield to hospital care to 60 minutes—the so called “golden hour.”

According to the researchers, transport time was reduced by 52% to a mean of 73 minutes, and the study “…showed a significant survival benefit after the mandate, specifically as a result of a reduction in KIA [killed in action] mortality.” This decrease persisted despite an increase in the severity of injuries being treated as method of injury shifted from gunshots to explosions as the wars progressed.

Despite acknowledged limitations of the study, the authors note, “the data show that…shorter transport times and enhancements to treatment capability…improved outcomes and potentially saved 359 lives.”

In his invited commentary on the study, “The Power of Advanced Capability and Informed Policy,” Col Todd E. Rasmussen, MD, Director of the US Combat Casualty Care Research Program, notes that reduction in the KIA percentage following the policy change provides evidence of an enhanced capability during the golden hour after injury that includes enhanced point of injury care and en route platforms, in addition to the reduction in transport time.

Rasmussen cautions against a “mission-complete” reaction, however, suggesting that future casualty care scenarios may be more complex and that military and civilian planners should “learn from the whole of the effort…and develop better ways to build trauma care capability and inform policy for future, more complex casualty scenarios.”

Read the article and commentary



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