An Analysis of Patient Movements during Sustained Combat Operations in the US Central Command: Implications for Remote Support Capabilities.

BACKGROUND:The US Central Command (CENTCOM) area of responsibility (AOR) spans 20 nations in the Middle East, Central, and South Asia. Evacuations outside this AOR include all injury types and severities; however, it remains unclear what proportion of evacuations were due to disease and non-battle injuries (DNBI). Understanding these patterns may be useful for defining future medical support requirements for multi domain operations (MDO). We sought to analyze encounters obtained from the Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) data for medical evacuations within CENTCOM. METHODS:We obtained all encounters within TRAC2ES from February 2009 to November 2018. We analyzed data using entered demographic data and keyword categorization of free text information provided by the medical officer requesting patient movement. RESULTS:There were 50,036 patient movement requests entered into TRAC2ES originating from the CENTCOM AOR for both military and civilian personnel. After removal of ineligible entries (for example, military working dogs), the number of eligible subjects was 49,259, 13 percent combat (n equals 6,389) and 87 percent were noncombat (n equals 42,870). The primary age group requiring evacuation was 18 through 29 (59 percent) and were mostly male (87 percent). Most went by routine status (80 percent), followed by priority (16 percent). Most of the transfers originated from Afghanistan (58 percent) and Iraq (22 percent), with Germany serving as the primary destination (79 percent). Results showed the total number of patient evacuations increased from 2009 to 2010 and then decreased from 2011 to 2017. The most frequent body region associated with the transfer was the extremities for both combat (54 percent) and noncombat (32 percent). CONCLUSIONS:Out of theater disease and non combat injury evacuation rates were nearly 7 times higher than for combat related injuries. Our results highlight the need for additional research and development resources of DNBI related medical care. As we move into future MDO with limited evacuation capabilities, we will need support solutions to cover the full gamut of DNBI.