{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T21:32:56Z","timestamp":1779399176315,"version":"3.53.1"},"reference-count":28,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2015,9,21]]},"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Combat casualty care is a complex system involving multiple clinicians, medical interventions and casualty transfers. Improving the performance of this system requires examination of potential weaknesses. This study reviewed the cause and timing of death of casualties deemed to have died from their injuries after arriving at a medical treatment facility during the recent conflicts in Iraq and Afghanistan, in order to identify potential areas for improving outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective review of all casualties who reached medical treatment facilities alive, but subsequently died from injuries sustained during combat operations in Afghanistan and Iraq. It included all deaths from start to completion of combat operations. The UK military joint theatre trauma registry was used to identify cases, and further data were collected from clinical notes, postmortem records and coroner's reports.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 71 combat-related fatalities who survived to a medical treatment facility; 17 (24%) in Iraq and 54 (76%) in Afghanistan. Thirty eight (54%) died within the first 24\u2005h. Thirty-three (47%) casualties died from isolated head injuries, a further 13 (18%) had unsurvivable head injuries but not in isolation. Haemorrhage following severe lower limb trauma, often in conjunction with abdominal and pelvic injuries, was the cause of a further 15 (21%) deaths.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Severe head injury was the most common cause of death. Irrespective of available medical treatment, none of this group had salvageable injuries. Future emphasis should be placed in preventative strategies to protect the head against battlefield trauma.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2015-000490","type":"journal-article","created":{"date-parts":[[2015,10,14]],"date-time":"2015-10-14T21:39:20Z","timestamp":1444858760000},"page":"355-360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":67,"title":["Died of wounds: a mortality review"],"prefix":"10.1136","volume":"162","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3864-3867","authenticated-orcid":false,"given":"Damian Douglas","family":"Keene","sequence":"first","affiliation":[{"name":"Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JG","family":"Penn-Barwell","sequence":"additional","affiliation":[{"name":"Institute of Naval Medicine, Gosport, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PR","family":"Wood","sequence":"additional","affiliation":[{"name":"Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK"},{"name":"Department of Anaesthesia, Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Hunt","sequence":"additional","affiliation":[{"name":"Forensic Pathology Services Wantage, Oxon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Delaney","sequence":"additional","affiliation":[{"name":"South West Group Practice, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Clasper","sequence":"additional","affiliation":[{"name":"Centre for Blast Injury Studies, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RJ","family":"Russell","sequence":"additional","affiliation":[{"name":"Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PF","family":"Mahoney","sequence":"additional","affiliation":[{"name":"Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK"},{"name":"Centre for Blast Injury Studies, Imperial College, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,10,14]]},"reference":[{"key":"2025081310130766000_162.5.355.1","unstructured":"Op Herrick casualty and fatality tables to 28 February 2015. https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/413527\/20150310_British_casualties_in_Afghanistan_7Oct01_to_28Feb15.pdf (accessed 10 Jun 2015)."},{"key":"2025081310130766000_162.5.355.2","unstructured":"British fatalities Operations in Iraq. https:\/\/www.gov.uk\/government\/fields-of-operation\/iraq (accessed Jul 2015)."},{"key":"2025081310130766000_162.5.355.3","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-155-02-09"},{"key":"2025081310130766000_162.5.355.4","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-153-04-03"},{"key":"2025081310130766000_162.5.355.5","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-157-03s-09"},{"key":"2025081310130766000_162.5.355.6","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3180654134"},{"key":"2025081310130766000_162.5.355.7","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-157-03s-04"},{"key":"2025081310130766000_162.5.355.8","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-155-04-16"},{"key":"2025081310130766000_162.5.355.9","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq110"},{"key":"2025081310130766000_162.5.355.10","doi-asserted-by":"crossref","first-page":"1014","DOI":"10.1097\/TA.0000000000000580","article-title":"Improved survival in UK combat casualties from Iraq and Afghanistan: 2003\u20132012","volume":"78","author":"Penn-Barwell","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081310130766000_162.5.355.11","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-153-04-04"},{"key":"2025081310130766000_162.5.355.12","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2013-000215"},{"key":"2025081310130766000_162.5.355.13","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-199712000-00009"},{"key":"2025081310130766000_162.5.355.14","unstructured":"Association for the Advancement of Automotive Medicine. 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Barrington, Illinois, 2005."},{"key":"2025081310130766000_162.5.355.15","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197403000-00001"},{"key":"2025081310130766000_162.5.355.16","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2010.0232"},{"key":"2025081310130766000_162.5.355.17","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/milmed\/149.2.55","article-title":"The causes of death in conventional land warfare: implications for combat casualty care research","volume":"149","author":"Bellamy","year":"1984","journal-title":"Mil Med"},{"key":"2025081310130766000_162.5.355.18","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/TA.0b013e31823e20a0","article-title":"Mortality and morbidity from combat neck injury","volume":"72","author":"Breeze","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081310130766000_162.5.355.19","first-page":"S51","article-title":"An analysis of in-hospital deaths at a modern combat support hospital","volume":"66","author":"Martin","year":"2009","journal-title":"J Trauma"},{"key":"2025081310130766000_162.5.355.20","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318221147b"},{"key":"2025081310130766000_162.5.355.21","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182755dcc"},{"key":"2025081310130766000_162.5.355.22","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1001\/jamasurg.2014.940","article-title":"Changing patterns of in-hospital deaths following implementation of damage control resuscitation practices in US forward military treatment facilities","volume":"149","author":"Langan","year":"2014","journal-title":"JAMA surgery"},{"key":"2025081310130766000_162.5.355.23","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.injury.2013.12.004","article-title":"Outcome of penetrating intracranial injuries in a military setting","volume":"45","author":"Smith","year":"2014","journal-title":"Injury"},{"key":"2025081310130766000_162.5.355.24","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000000136"},{"key":"2025081310130766000_162.5.355.25","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000000085"},{"key":"2025081310130766000_162.5.355.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2011.07.001"},{"key":"2025081310130766000_162.5.355.27","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bjoms.2014.04.017","article-title":"Novel method for comparing coverage by future methods of ballistic facial protection","volume":"53","author":"Breeze","year":"2015","journal-title":"Br J Oral Maxillofac Surg"},{"key":"2025081310130766000_162.5.355.28","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2013-000108"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2015-000490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T17:13:14Z","timestamp":1755105194000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2015-000490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,14]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2016,9,27]]},"published-print":{"date-parts":[[2016,10]]}},"alternative-id":["10.1136\/jramc-2015-000490"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2015-000490","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,14]]}}}