A US Military Role 2 Forward Surgical Team Database Study of Combat Mortality in Afghanistan

BACKGROUND Timely and optimal care can reduce mortality among critically injured combat casualties. US military Role 2 surgical teams were deployed to forward positions in Afghanistan on behalf of the battlefield trauma system. They received prehospital casualties, provided early damage control resuscitation and surgery, and rapidly transferred casualties to Role 3 hospitals for definitive care. A database was developed to capture Role 2 data. METHODS A retrospective review and descriptive analysis was conducted of battle-injured casualties transported to US Role 2 surgical facilities in Afghanistan from February 2008 to September 2014. Casualties were analyzed by mortality status and location of death (pre, intra, or post transport), military affiliation, transport time, injury type and mechanism, combat mortality index-prehospital (CMI-PH), and documented prehospital treatment. RESULTS Of 9,557 casualties (median age, 25.0; male 97.4%), most (95.1%) survived to transfer from Role 2 facility care. Military affiliation included US coalition forces (37.4%), Afghanistan National security forces (23.8%), civilian/other forces (21.3%), Afghanistan National police (13.5%), and non-US coalition forces (4.0%). Mortality differed by military affiliation (p

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