A Descriptive Analysis of Notional Casualties Sustained at the Joint Readiness Training Center: Implications for Health Service Support during Large-Scale Combat Operations.

Abstract

Introduction: The Joint Readiness Training Center (JRTC) offers a laboratory for study of combat casualty care delivery during brigade-sized collective training exercises. We describe the casualty outcomes during largescale combat operations as part of a JRTC rotation.

Methods: During JRTC rotation 20-02, 2/4 Infantry Brigade Combat Team (IBCT) participated in force on force operations as part of a joint and multinational task force. Medical assets available included a Role II associated with the Brigade Support Medical Company and Role I facilities associated with six subordinate battalion elements. Observers, coaches, and trainers (OCTs) categorized all casualties as killed in action (KIA) or wounded in action (WIA). OCTs categorized WIA casualties as died of wounds (DOW) based upon time elapsed from time of injury to transportation to successive roles of care within time standards, dependent upon the severity of injuries. We portrayed our DOW rates using descriptive statistics.

Results: Force on force operations spanned 14 days. The task organization comprised 3,820 persons. Casualties included 642 KIA and 1061 WIA. Of the WIA, 502 (47.3%) dies from their wounds. The primary reason for DOW was evacuation delay from point of injury (POI) to military treatment facility (MTF) (443 casualties, 88.2%). An additional 40 casualties DOW at the Role 1 (8.0%) and 10 died at Role II (2.0%). Nine casualties (1.8%) DOW due to improper care rendered.

Discussion: Casualty DOW during simulated large-scale combat operations are overwhelmingly due to evacuation delays from POI. Medical readiness for near-peer force on force operations depends upon shared understanding across medical and non-medical personnel of casualty movement through echelons of care on the battlefield.