Factors influencing humanitarian care and the treatment of local patients within the deployed military medical system: casualty referral limitations (original) (raw)
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Journal of Archives in Military Medicine, 2016
Background: The North Atlantic treaty organization (NATO)-led international security and assistance force (ISAF) conducted training, development, and humanitarian activities in addition to security operations during its 13 years in Afghanistan. Objectives: The aim of this study was to present the emergency department experiences of Kabul Ataturk Role II military hospital. Materials and Methods: We performed a retrospective observational study of emergency department admissions at Kabul Ataturk Role II Military hospital during a 12-month period from August 2012 through July 2013. Results: During the 12-month study period, 4348 patients were admitted to our emergency department. Admissions were evaluated as two groups according to trauma exposure of the patients and we detected that the Afghan civilian group had a higher number of admissions with stab wounds and burn injuries compared to the other groups. Moreover, our study results presents higher rates of surgical, orthopedic, and mixed treatments on the Afghan civilian group compared with other groups of patients. Conclusions: Humanitarian care facilities, including medical assistance, are still vital for the Afghan society. Participation of women and/or Muslim caregivers may enhance accessibility, particularly for Afghan women. We believe that the availability of emergency medicine facilities in a hospital setting at a reachable location for Afghan civilians is an effective and profitable choice for medical services. In terms of emergency medicine, the department should be prepared for orthopedic traumas, combat injuries including mine and gunshot wounds, and burn injuries.
International journal of emergency medicine, 2015
Afghanistan has struggled with several decades of well-documented conflict, increasing the importance of providing emergency services to its citizens. However, little is known about the country's capacity to provide such care. Three native-speaking Afghan-American physicians performed an assessment of emergency care via combined quantitative and qualitative survey tools. Hospitals in Kabul, Afghanistan were selected based on probability proportional to size methodology, in which size was derived from prior work in the country and permission granted by the administering agency and the Ministry of Health. A written survey was given to physicians and nurses, followed by structured focus groups, and multiple days of observation per facility. A descriptive analysis was performed and data analyzed through a combination of variables in eight overarching categories relevant to emergency care. One hundred twenty-five surveys were completed from 9 hospitals. One third of respondents (32.8...
Military medicine, 2017
Few published reports have examined the numbers of civilian injuries treated at Military Treatment Facilities in the Afghan Theater of Operations. However, review of Department of Defense Trauma Registry revealed a persistent percentage of civilians treated by NATO, and this study compares the proportion of civilians served by Afghan and Coalition military hospitals between 2009 and 2013. A retrospective review of records from Department of Defense trauma Registry for Coalition data, and Afghan data from the Office of the Inspector General. We assessed changes in the proportion of civilians served between 2009 and 2013 at Afghan and Coalition hospitals. There was a significant percentage (≥21.55%) of civilians served at both Afghan and Coalition hospitals. Although the total population of Afghan Nationals treated remained steady, the number of total civilians decreased over this time period. To account for this, the percentage of military personnel increased at Afghan military hospi...
The Cost of Providing Health Care to Injured Soldiers in War
The Journal of Trauma: Injury, Infection, and Critical Care, 2009
Background: As the Global War on Terror progresses, the total health cost for treating wounded soldiers continues to rise. Although some reports have estimated the total cost of soldiers' health care, no study has attempted to rigorously quantify this amount. We sought to quantify the cost of providing health care to soldiers injured while on duty in a conflict area. Methods: Retrospective study of all Canadian Forces (CF) soldiers injured in Afghanistan from February 7, 2006, to February 6, 2007. CF trauma registry was used to identify all injured Canadian soldiers and hospitalized at the military field hospital in Kandahar. Financial reports from the Canadian Forces Health Services were used to quantify the cost of providing care to these soldiers in Kandahar at Landstuhl Regional Medical Center and during evacuation back to Canada. Insurance claims paid (as of October 15, 2007) to a third-party insurer by the CF were used to quantify the charges and costs of health care in Canada. All dollar figures are in Canadian dollars. Results: During the 1-year period, the CF spent more than 24.3milliontoprovidehealthcareto1,245patientsatitsfieldhospitalinKandahar.Onehundredtwenty−sevenofthesepatientswereinjuredCanadiansoldierswhorequiredadmissiontothefieldhospital.Atotalof93soldiersrequiredevacuationtoLandstuhlRegionalMedicalCenter,andofthese,75requiredfurthercareattheCanadiancivilianhospitals.TheCFspentapproximately24.3 million to provide health care to 1,245 patients at its field hospital in Kandahar. One hundred twenty-seven of these patients were injured Canadian soldiers who required admission to the field hospital. A total of 93 soldiers required evacuation to Landstuhl Regional Medical Center, and of these, 75 required further care at the Canadian civilian hospitals. The CF spent approximately 24.3milliontoprovidehealthcareto1,245patientsatitsfieldhospitalinKandahar.Onehundredtwenty−sevenofthesepatientswereinjuredCanadiansoldierswhorequiredadmissiontothefieldhospital.Atotalof93soldiersrequiredevacuationtoLandstuhlRegionalMedicalCenter,andofthese,75requiredfurthercareattheCanadiancivilianhospitals.TheCFspentapproximately2.5 million to provide trauma care in Kandahar to its 127 injured soldiers.
En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan
Critical care nurse, 2018
En route care is the transfer of patients requiring combat casualty care within the US military evacuation system. No reports have been published about en route care of patients during transfer from a forward surgical facility (role 2) to a combat support hospital (role 3) for comprehensive care. To describe patients transferred from a role 2 to a role 3 US military treatment facility in Afghanistan. A retrospective review of data from the Joint Trauma System Role 2 Database was conducted. Patient characteristics were described by en route care medical attendants. More than one-fourth of patients were intubated at transfer (26.9%), although at transfer fewer than 10% of patients had a base deficit of more than 5 (3.5%), a pH of less than 7.3 (5.2%), an international normalized ratio of more than 2 (0.8%), or temporary abdominal or chest closure (7.4%). The en route care medical attendant was most often a nurse (35.5%), followed by technicians (14.1%) and physicians (10.0%). Most pat...
Pain Medicine, 2012
Objective. The primary goal of this investigation was to survey military health care professionals at a Camp Bastion, Afghanistan, regarding their perceptions of care delivered by an anesthesiologistdirected acute pain service (APS) at a British Combat Support Hospital (CSH)-Role 3. Methods. The APS was directed by a U.S. Army anesthesiologist experienced in acute pain medicine who established an APS within a deployed British CSH. A brief 15-item survey was developed to assess impressions of outcomes, complexity of care, and satisfaction with the APS. Content validity was established through limited published surveys of APSs, expert review, and end user evaluation. Results. The sample (N = 70, of which 61.4% were male) included 50% nurses, 15.8% surgeons, and 10% anesthesiologists who completed the survey at the end of the 3-month APS implementation period. Approximately 75% of the sample agreed or strongly agreed that injured soldiers managed by an APS obtained better pain relief than those who were not. With a 10-point scale, respondents rated how satisfied they were with the APS (mean 7.70 Ϯ 1.7), how beneficial it was for patients (7.89 Ϯ 2), and how important it would be to deploy an APS again to a level 3 facility (8.52 Ϯ 1.7). Internal consistency reliability (Cronbach's alpha) for the 12-items measuring perceptions was acceptable, alpha = 0.82. Conclusions. Overall, the majority of military health care survey responders indicated support for an APS team as part of a CSH care, and confirmed its contributions to improving trauma care.
Medical support of military operations in Iraq and Afghanistan
International maritime health
The system of medical support in the territory of military operations in Iraq and Afghanistan is based on four levels of medical treatment. Level 4 is organized outside the war theatre, in the territories of the countries that are a part of the stabilization forces of international organizations (NATO). Both the tasks and the structure of medical support are adjusted to fit the requirements of the U.S. Forces. The same tasks and structure are also recognized by medical services of other NATO countries participating in military operations in Iraq and Afghanistan. Each subsequent level of medical support is progressively more highly specialized and capable of providing more advanced medical treatment in comparison to the preceding level. Medical evacuation is executed either by air or overland depending on the type of illness or injury as well as the tactical situation prevailing in the combat zone. The aim of this paper is to present the planning, challenges, and problems of medical assistance in the contemporary battlefield.
Prehospital Interventions Performed in Afghanistan Between November 2009 and March 2014
Military Medicine, 2019
ObjectiveCare provided to a casualty in the prehospital combat setting can influence subsequent medical interactions and impact patient outcomes; therefore, we aimed to describe the incidence of specific prehospital interventions (lifesaving interventions (LSIs)) performed during the resuscitation and transport of combat casualties.MethodsWe performed a prospective observational, IRB approved study between November 2009 and March 2014. Casualties were enrolled as they were cared for at nine U.S. military medical facilities in Afghanistan. Data were collected using a standardized collection form. Determination if a prehospital intervention was performed correctly, performed incorrectly, or was necessary but was not performed (missed LSIs) was made by the receiving facility’s medical provider.ResultsTwo thousand one hundred and six patients met inclusion criteria. The mean age was 25 years and 98% were male. The most common mechanism of injury was explosion 57%. There were 236 airway ...