Lessons from the Fallen: An After-Action Review of Prehospital Casualty Data during the Global War on Terror.

Background: The US military's recent involvement in long standing conflict has caused the pioneering of many lifesaving medical advances, often made possible by data-driven research. However, future advances in battlefield medicine will likely require greater data fidelity than is currently attainable. Continuing to improve survival rates will require data which establishes the relative contributions to preventable mortality and guides future interventions. Prehospital data, particularly that from Tactical Combat Casualty Care (TCCC) Cards and TCCC After Action Reports (TCCC AARs), are notoriously inconsistent in reaching searchable databases for formal evaluation. While the military has begun incorporating more modern technology in advanced data capture over the past few years like the Air Force's Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) and the Army's Medical Hands-free Unified Broadcast system (MEDHUB), more analysis weighing the advantages and disadvantages of substituting analog solutions is needed.

Discussion: We propose 3 changes which may aid prehospital data capture and facilitate analysis: reexamine the current format of TCCC Cards and consider reducing the number of available datapoints to streamline completion, implement a military-wide mandate for all Role 1 providers to complete a TCCC AAR within 24 hours of a casualty event, and formalize the process of requesting de-identified data from the Armed Forces Medical Examiner System (AFMES) database.

Conclusion: Reflecting on the state of US military medicine after 20 years of war, an important focus is improving the way prehospital data is gathered and analyzed by the military. There are steps we can take now to enhance our capabilities.