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J R Army Med Corps. 2019 Jun 20. pii: jramc-2019-001228. doi: 10.1136/jramc-2019-001228. [Epub ahead of print]

Damage control resuscitation and surgery for indigenous combat casualties: a prospective observational study.

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HQ DPHC (NIWW), Venning Barracks, Donnington, Telford, UK
Academic Department of Military Surgery and Trauma, Birmingham, UK.
Department of Surgery, Uniformed Services University, Bethesda, Maryland, USA.
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.



Specialist units that assist indigenous forces (IF) in their strategic aims are supported by medical teams providing point of injury emergency care for casualties, including IF and civilians (Civ). We investigated the activities of a Coalition Forces far-forward medical facility, in order to inform medical providers about the facilities and resources required for medical support to IF and Civ during such operations.


A prospective observational study (June to August 2017) undertaken at a far-forward Coalition Forces medical support unit (12 rotating personnel) recorded patient details (IF or Civ), mechanism of injury (MOI), number of blood products used, damage control resuscitation (DCR) and damage control surgery (DCS), number of mass casualty (MASCAL) scenarios, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA) and whole blood emergency donor panels (EDP).


680 casualties included 478 IF and 202 Civ (45.5% of the Civ were paediatric). Most common MOIs were blast (n=425; 62.5%) and gunshot wound (n=200; 29.4%). Fifteen (2.2%) casualties died; 627 (92.2%) were transferred to local hospitals. DCR was used for 203 (29.9%), and DCS for 182 (26.8%) casualties. There were 23 MASCAL scenarios, 1220 transfusions and 32 EDPs. REBOA was performed eight times, and thoracotomy was performed 27 times.


A small medical team provided high-tempo emergency resuscitative care for hundreds of IF and Civ casualties within a short space of time using state-of-the-art resuscitative modalities. DCR and DCS were undertaken with a large number of EDPs, and a high survival-to-transfer rate.


accident and emergency medicine; adult intensive and critical care; organisation of health services; surgery; trauma management


Conflict of interest statement

Competing interests: None declared.

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