Abstract：
BACKGROUND: Over the course of the US\' Global War on Terrorism, its military has utilized both conventional and special operations forces (SOF). These entities have sustained and treated battlefield casualties in the prehospital, Role 1 setting, while also making efforts to mitigate risks to the force and pursuing improved interventions. The goal of this study is to compare outcomes and prehospital medical interventions between SOF and conventional military combat casualties.
METHODS: This is a secondary analysis of previously published data from the Department of Defense Trauma Registry. The casualties were categorized as special operations if they were 18-series, Navy SEAL, Pararescue Jumper, Tactical Air Control Party, Combat Controller, and Marine Corps Force Reconnaissance. The remainder with a documented military occupational specialty (MOS) were classified as conventional forces.
RESULTS: Within our dataset, a MOS was categorizable for 1806 conventional and 130 special operations. Conventional forces were younger age (24 versus 30, p is less than 0.001). Conventional forces had a higher proportion of explosive injuries (61% versus 44%) but a lower proportion of firearm injuries (22% versus 42%, p is less than 0.001). The median injury severity scores were similar between the groups. Conventional forces had lower rates of documentation for all metrics: pulse, respiratory rate, blood pressure, oxygen saturation, Glasgow Coma Scale, and pain score. On adjusted analyses, SOF had higher odds of receiving an extremity splint, packed red blood cells, whole blood, tranexamic acid, ketamine, and fentanyl.
CONCLUSIONS: SOF had consistently better medical documentation rates, more use of ketamine and fentanyl, less morphine administration, and lower threshold for use of blood products in both unadjusted and adjusted analyses. Our findings suggest lessons learned from the SOF medics should be extrapolated to the conventional forces for improved medical care.
METHODS: This is a secondary analysis of previously published data from the Department of Defense Trauma Registry. The casualties were categorized as special operations if they were 18-series, Navy SEAL, Pararescue Jumper, Tactical Air Control Party, Combat Controller, and Marine Corps Force Reconnaissance. The remainder with a documented military occupational specialty (MOS) were classified as conventional forces.
RESULTS: Within our dataset, a MOS was categorizable for 1806 conventional and 130 special operations. Conventional forces were younger age (24 versus 30, p is less than 0.001). Conventional forces had a higher proportion of explosive injuries (61% versus 44%) but a lower proportion of firearm injuries (22% versus 42%, p is less than 0.001). The median injury severity scores were similar between the groups. Conventional forces had lower rates of documentation for all metrics: pulse, respiratory rate, blood pressure, oxygen saturation, Glasgow Coma Scale, and pain score. On adjusted analyses, SOF had higher odds of receiving an extremity splint, packed red blood cells, whole blood, tranexamic acid, ketamine, and fentanyl.
CONCLUSIONS: SOF had consistently better medical documentation rates, more use of ketamine and fentanyl, less morphine administration, and lower threshold for use of blood products in both unadjusted and adjusted analyses. Our findings suggest lessons learned from the SOF medics should be extrapolated to the conventional forces for improved medical care.
摘要：
背景：在美国的全球反恐战争中，它的军队使用了常规和特种作战部队（SOF）。这些实体在院前治疗了战场上的伤亡，角色1设置,同时努力减轻部队的风险，并寻求改进干预措施。这项研究的目的是比较SOF和常规军事战斗伤亡之间的结果和院前医疗干预措施。
方法：这是对国防部创伤登记处先前发布的数据的二次分析。如果伤亡者是18系列，则被归类为特殊行动，海豹突击队,救援跳线，战术空中控制方,战斗控制员,和海军陆战队部队侦察。其余有记录的军事职业专业（MOS）被归类为常规部队。
结果：在我们的数据集中，MOS可分为1806年常规行动和130年特殊行动。常规部队年龄较小（24对30，p小于0.001）。常规部队的爆炸伤害比例较高（61％对44％），但枪支伤害比例较低（22％对42％，p小于0.001)。两组之间的中位损伤严重程度评分相似。常规部队对所有指标的记录率都较低：脉搏，呼吸频率,血压,氧饱和度,格拉斯哥昏迷量表，和疼痛评分。在调整后的分析中，SOF接受四肢夹板的几率更高，充血的红细胞,全血,氨甲环酸,氯胺酮,还有芬太尼.
结论：SOF的医疗记录率一直较高，更多使用氯胺酮和芬太尼，减少吗啡的使用,以及在未调整和调整分析中使用血液制品的较低阈值。我们的发现表明，从SOF医务人员那里吸取的教训应该外推到常规部队，以改善医疗保健。
方法：这是对国防部创伤登记处先前发布的数据的二次分析。如果伤亡者是18系列，则被归类为特殊行动，海豹突击队,救援跳线，战术空中控制方,战斗控制员,和海军陆战队部队侦察。其余有记录的军事职业专业（MOS）被归类为常规部队。
结果：在我们的数据集中，MOS可分为1806年常规行动和130年特殊行动。常规部队年龄较小（24对30，p小于0.001）。常规部队的爆炸伤害比例较高（61％对44％），但枪支伤害比例较低（22％对42％，p小于0.001)。两组之间的中位损伤严重程度评分相似。常规部队对所有指标的记录率都较低：脉搏，呼吸频率,血压,氧饱和度,格拉斯哥昏迷量表，和疼痛评分。在调整后的分析中，SOF接受四肢夹板的几率更高，充血的红细胞,全血,氨甲环酸,氯胺酮,还有芬太尼.
结论：SOF的医疗记录率一直较高，更多使用氯胺酮和芬太尼，减少吗啡的使用,以及在未调整和调整分析中使用血液制品的较低阈值。我们的发现表明，从SOF医务人员那里吸取的教训应该外推到常规部队，以改善医疗保健。
