Transport time after combat-related injury and patient-reported outcomes among US service members.

INTRODUCTION: The 'golden hour' is a universal paradigm that suggests trauma patients have lower morbidity and mortality when provided with medical care within 1 hour after injury. The objective of this study was to examine whether transport time from point of injury to a military treatment facility (MTF) in-theatre was associated with patient-reported outcomes, such as post-traumatic stress disorder (PTSD), depression and quality of life (QOL), among US service members with combat-related injury. METHODS: Participants were injured between March 2003 and March 2016 and completed standardised assessments of PTSD, depression and QOL for theWounded Warrior Recovery Project (WWRP) between January 2013 and November 2017. Multivariable regressions were used to assess the relationship between transport time (≤1 hour or >1 hour from injury to MTF) and positive screens for PTSD and depression, and QOL, respectively.Overall, 45.6% of participants (n=879) arrived at an MTF within 1 hour postinjury. About 8 years passed between when participants were injured on deployment and when they completed their first WWRP assessment. Approximately 48% of participants screened positive for PTSD and 51.3% for depression, with a mean QOL score of 0.513 (SD=0.150). After adjusting for covariates, transport time was not significantly associated with PTSD (OR 1.04, 95% CI 0.79 to 1.38; p=0.77), depression (OR 0.92, 95% CI 0.69 to 1.21; p=0.55) or QOL (ß=0.009; p=0.38). CONCLUSION: Transport time was not associated with patient-reported outcomes among US service members with combat-related injury. These findings are important as we seek to understand how combat casualties may be affected by extended medical evacuation or transport times anticipated in future expeditionary operations.

Development of a medical supply set for corpsmen in the field.

Fleet Marine Force corpsmen are the first medical responders to treat casualties in the field. They carry an outdated bag of supplies called the surgical instrument and supply set. The purpose of this investigation is to develop an updated supply set for field corpsmen by linking each supply item to specific medical tasks conducted in the field, which then creates an audit trail. The review of medical supplies generated an updated list of supplies to be carried by corpsmen in a new medical module and a list of items that corpsmen can pull from the battalion aid station authorized medical allowance lists as needed. Items without a clinical requirement were not included. This improved set of supplies for corpsmen will greatly enhance treatment capability in the field. As technology and needs change, replacements, additions, and deletions of the items can easily be made.

Estimating supply requirements for forward medical treatment facilities.

The Naval Health Research Center designed, developed, and used a systematic process to review Marine Corps medical supply requirements. This approach consisted of identifying the medical tasks required to treat patients with specific injuries and illnesses and determining the supplies and equipment required to perform each task. Subject matter experts reviewed treatment briefs, tasks, supplies, and equipment and examined their value to Marine Corps medical providers in forward areas of care. By establishing the clinical requirement for each item pushed forward, the Naval Health Research Center model was able to reduce the logistical burden carried by Marine Corps units and enhance far-forward clinical capability. The result of this effort is a model to estimate supplies and equipment based on a given casualty stream distribution. This approach produces an audit trail for each item and allows current authorized medical allowance list configurations to be revised using information such as type of conflict anticipated, expected duration, and changes in medical doctrine.

A system for tracking patients at forward medical treatment facilities.

A computerized, prototype patient tracking system, designed for a forward medical treatment facility (MTF), was developed and tested. The system, named MEDTRAK, was tested in a side-by-side comparative evaluation with the current manual method of patient tracking. Results of the evaluation showed that the MEDTRAK system admitted, identified, and tracked patients within the MTF significantly more accurately than did the current manual system. Furthermore, the types of tracking errors produced by the manual system were found to be more detrimental to both the effective operation of the MTF and to the discharge of theater evacuation policy than were those produced by the MEDTRAK system. In addition to improved patient accountability, the MEDTRAK system reduced the administrative burden that patient tracking placed on medical personnel, thereby allowing them to perform clinical duties.