Understanding the Intricacies of Military Trauma Care and Combat Casualty Mortality Analysis- COL(R) Russ S. Kotwal, MD, MPH

Military Medicine & WarDocs present: "Insights and Take-Home Messages from the Author"

Article Title: United States Military Fatalities During Operation Inherent Resolve and Operation Freedom’s Sentinel

Military Medicine, Volume 188, Issue 9-10, September/October 2023, Pages 3045–3056

Link to Article: https://academic.oup.com/milmed/article/188/9-10/3045/6584429

Episode Summary:

      Join us as retired Army Colonel Dr. Russ Kotwal takes us through the complexities of analyzing military fatalities in combat operations discussing his recent article in Military Medicine. Drawing from his extensive experience and in-depth research, Dr. Kotwal breaks down how changes in military missions, resources, and roles of engagement over time can influence the outcome of these operations. You'll gain valuable insights into the significance of mortality reviews from previous major military operations in guiding injury prevention and future combat casualty care efforts. Also, we take time to clarify important terms such as 'DNBI' and 'Battle Injury', and their relevance to cause of death.

     In our discussion, we venture into the realm of military medical terminology used to define battle injuries and casualties. Listen in as we fully define terms like killed in action, died of wounds, injury survivability, and death preventability. To help you understand these terms and their meanings better, we explore the Joint Trauma System lexicon, an indispensable tool in military trauma care.

     Don't miss out as we dissect the case fatality rate for battle injuries in the context of combat casualty care. We look at data from World War II, Vietnam, Afghanistan, and Iraq, and draw comparisons between OIR and OFS. We also touch on the role of the Joint Trauma System and the Department of Defense Trauma Registry and their potential impact on the case fatality rate in large-scale combat operations. Our discussion extends to the examination of autopsy reports and the implications they carry for garrison care and the readiness of the medical force. Join us in this enlightening exploration of military trauma mortality and injury severity.

Episode Chapters:

(0:00:00) - Analyzing Military Fatalities in Combat Operations

Dr. Kotwal discusses military missions, resources, mortality reviews, DNBI and Battle Injury, and injury prevention for combat casualty care.

(0:05:29) - Military Trauma Care Medical Terms

We discuss military battle injuries, casualties, KIA/DOW, survivability, death preventability, and the joint trauma lexicon.

(0:21:07) - Analyzing Case Fatality Rates and Lessons

We compare case fatality rates of battle injuries in WW2, Vietnam, Afghanistan and Iraq, examining the Joint Trauma System, DoD Trauma Registry, and autopsy reports.

(0:30:22) - Military Trauma Mortality and Injury Severity

Hemorrhage, injury severity scores, blast and gunshot wounds, and future Mortality analysis projects are discussed.

**CORRECTION**-  The Army Air Corps vignette discussed at 37:55 in the podcast occurred in 1943.

Take Home Messages:

1. Understanding military missions, resources, and roles of engagement is crucial in analyzing the outcomes of combat operations and informing future casualty care efforts.
2. The terms 'DNBI' and 'Battle Injury' play a key role in understanding the cause of death in combat scenarios.
3. Military medical terminology such as 'killed in action', 'died of wounds', 'injury survivability', and 'death preventability' are critical in the analysis of military trauma care.
4. The Joint Trauma Lexicon is an invaluable tool that helps in understanding complex military medical terms and their meanings.
5. The case fatality rate for battle injuries has