Injury survivability and death preventability during recent conflicts in french combat fatalities: a retrospective study

Position du problème et objectif(s) de l’étude

Understanding combat mortality is vital to improving combat casualty outcomes. The “lessons learned” from cumulative evidence have helped to improve medical performance, iterative training, and reduce preventable death from extremity hemorrhage amenable to tourniquet placement, tension pneumothorax, and airway compromise. The efficacy of Tactical Combat Casualty Care is contingent upon the tactical environment, encompassing deployment conditions, the particulars of national military medical support, and the structure of military operations. This underscores the distinction between survivability and preventability of combat deaths, which includes the entire tactical situation's impact on combat casualty care. The primary objective of this study was to provide a comprehensive description of the survivability of the injuries and the preventability of death among the French fatalities service members (SMs) who sustained combat injuries during the last two decades of the war in the Sahel and Afghanistan.

Matériel et méthodes

This retrospective study included all French combat fatalities in overseas operations between 2008 and 2023. We collected information on demographics, injuries, life support interventions, and relevant delays. By assessing the number of Killed In Action (KIA) and Died Of Wounds (DOW), the Case Fatality Rate was calculated. For each combat fatality, we assessed the survivability of their injuries and the preventability of their death according to the Joint Trauma Lexicon. A case review was conducted to identify opportunities for improvement (OFI).

Résultats & Discussion

Of the 123 patients who met the inclusion criteria, 74.7% were classified as KIA. The CFR decreased over the period study, from 17.4% to 13.1%, p = 0.48. The overall population sustained a median of 3 severe injuries [2.0 - 4.0], with the head-neck region being the primary involved injury (38.9%). Gunshot wounds accounted for 37.4% of fatalities as the primary mechanism of injury. Non-survivable injuries comprised 66.7% of the entire cohort, potentially survivable injuries 30.9% of the cohort, and survivable injuries 2.4% of the cohort. Non-preventable death represented 73.9% and potentially preventable death 26.1% of the population, and none died from preventable death. Fatalities from Sahelian operations sustained more explosion-related injuries (47.7% vs. 29.9%, p<0.001), resulting in more catastrophic tissue destruction (36.4% vs. 14.9%) without significant differences in death preventability. Median evacuation time between the POI to the first surgical MTF was notably higher for the Sahel DOW group (130.0 min [35.0 - 180.0] vs. 65.0 [43.8 - 111.8]) and half of fatalities with (potentially) survivable injuries did not survive to the “Golden Hour”. Among fatalities with (potentially) survivable injuries who DOW at Role 2, non-compressible torso hemorrhage (NCTH) was the mechanism of death in 57.1% of fatalities and junctional hemorrhage in 14.2% of fatalities. OFI were mainly focused on the prehospital setting(85.7%).

Conclusion

This paper presents the first description of French combat fatalities during the recent conflicts, with a particular focus on Sahel operations. The analysis revealed a decrease in the CFR and an increase in the DOW percentage among French combat fatalities. Most of them were classified as KIA having non-preventable death. Potentially preventable deaths were driven by NCTH and junctional hemorrhage where the primary site responsible for death was the chest and low extremities.

Auteurs

Johan SCHMITT (1) , Clément HOFFMANN (2), Henri DE LESQUEN (3), Nicolas PRAT (4), Dorian CELLARIER (5), Tristan MONCHAL (3), Paul BALANDRAUD (3), Eric MEAUDRE (1) - (1)Icu Military Teaching Hospital Sainte Anne, Toulon, France, (2)Icu Military Teaching Hospital Percy, Toulon, France, (3)Surgery Department, Military Teaching Hospital Sainte Anne, Toulon, France, (4)Irba, Combat Traumatology Department, Bretigny Sur Orge, France, Bretigny Sur Orge, France, (5)Military Legion Corps, First Legion Unit, Aubagne, France

Orateur(s)

Yassine BOUASSRIA ()