Army, Air Force mine databases to manage evacuations of wounded

The Army and Air Force have begun to use computer systems to better manage the medical evacuation of troops wounded on the battlefields in Afghanistan and Iraq, including a data management system that fine-tunes the process.

The Army enters information on every combat casualty as soon as possible into the Joint Theater Trauma Registry, which it uses to determine where to place trauma teams and medevac crews during combat, Lt. Gen. Eric Schoomaker, the Army surgeon general, told a hearing of the Senate Defense subcommittee on appropriations on Thursday.

It's a "delicate balancing act" in Afghanistan, where the operation of life-saving medevac helicopters needs to be balanced against risks to flight crews from hostile fire, he said. The Army does not want to wait to evacuate a seriously wounded soldier, but at the same time tries to avoid exposing flight crews to undue risk.

Real-time information about a soldier's wounds allows medical teams to determine how quickly he or she should be evacuated. The system then weighs that information against historical data on the hazards of conducting medevac missions in a particular area.

The Army also mines information in the registry to figure out how it could improve equipment to prevent combat wounds, including upgrading helmet goggles, body armor and vehicles. Lt. Col. William Geesey, commander of MC4, said analysis of data on wounds in the registry helped developers identify where they needed to better cover the body with armor, which led to more soldiers surviving attacks.

The Air Force evacuates casualties in Afghanistan and Iraq to either Landstuhl Army Medical Center in Germany or to U.S. hospitals within 24 hours. Lt. Gen. Charles Green, the Air Force's surgeon general, said at the hearing that the service has begun fielding a software suite to all deployed locations to manage the flights.

The Theater Medical Information Program Air Force software integrates clinical care documents, medical supplies, equipment and patient updates with the data stored at secure locations in the United States within 24 hours, he said.

Since November 2001, the Air Force has medevaced more than 70,000 patients from Afghanistan and Iraq, which has led to less than 10 percent of soldiers dying from their battlefield wounds, the best survival rate ever seen in war, Green said.

Evacuation of one patient can require coordination of multiple aircraft staffed by teams that consist of a physician, a critical care nurse and a cardiopulmonary technician.

In July 2009, for example, a British soldier in Afghanistan sustained multiple gunshot wounds and was so seriously wounded that medical teams had to replace his blood supply more than 10 times. To evacuate the patient, the Air Force had to use two planes to transport a medical team and equipment, and fly another aircraft to transport the patient to Germany.

After landing at Ramstein Air Base in Germany, the soldier was flown to a university hospital by helicopter. "This case highlights the dedication and compassion our personnel deliver in the complex but seamless care continuum," Green testified. "This tremendous effort contributes to our unprecedented survival rate."