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In World War II, soldiers admitted to trauma units had an expected mortality of 30%. This was reduced to 24% in Vietnam, and now, in the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) wars, case fatality rates have declined to less than 10%.1,2 Improved survival from battlefield injuries resulted from the military’s much greater emphasis on the development of a coordinated trauma system that was constantly undergoing reevaluation. In the September 2014 issue of JAMA Surgery, Langan and colleagues1 report the results from 57 179 soldiers admitted to forward combat hospital units from 2002 to 2011. With time, injury severity scores increased; however, survival improved. Better outcomes were associated with implementation of damage control resuscitation (DCR) protocols that, among other elements, emphasize less use of crystalloid and greater use of red blood cells (RBCs) and fresh-frozen plasma (FFP) (in a 1:1 FFP:RBC ratio). The use of DCR was associated with a reduction in deaths occurring within 7 days after injury from 10% to 6%.1
Holcomb JB, Hoyt DB. Comprehensive Injury Research. JAMA. 2015;313(14):1463-1464. doi:10.1001/jama.2014.16802