{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:39:40Z","timestamp":1755225580657,"version":"3.43.0"},"reference-count":17,"publisher":"BMJ","issue":"E","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Mil Health"],"accepted":{"date-parts":[[2019,3,29]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Historically, there has been variability in the methods for determining preventable death within the US Department of Defense. Differences in methodologies partially explain variable preventable death rates ranging from 3% to 51%. The lack of standard review process likely misses opportunities for improvement in combat casualty care. This project identified recommended medical and non-medical factors necessary to (1) establish a comprehensive preventable death review process and (2) identify opportunities for improvement throughout the entire continuum of care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This qualitative study used a modified rapid assessment process that includes the following steps: (1) identification and recruitment of US government subject matter experts (SMEs); (2) multiple cycles of data collection via key informant interviews and focus groups; (3) consolidation of information collected in these interviews; and (4) iterative analysis of data collected from interviews into common themes. Common themes identified from SME feedback were grouped into the following subject areas: (1) prehospital, (2) in-hospital and (3) forensic pathology.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Medical recommendations for military preventable death reviews included the development, training, documentation, collection, analysis and reporting of the implementation of the Tactical Combat Casualty Care Guidelines, Joint Trauma System Clinical Practice Guidelines and National Association of Medical Examiners autopsy standards. Non-medical recommendations included training, improved documentation, data collection and analysis of non-medical factors needed to understand how these factors impact optimal medical care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In the operational environment, medical care must be considered in the context of non-medical factors. For a comprehensive preventable death review process to be sustainable in the military health system, the process must be based on an appropriate conceptual framework implemented consistently across all military services.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jramc-2019-001193","type":"journal-article","created":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T12:03:54Z","timestamp":1556539434000},"page":"e47-e52","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Recommended medical and non-medical factors to assess military preventable deaths: subject matter experts provide valuable insights"],"prefix":"10.1136","volume":"166","author":[{"given":"Whitney Y","family":"Harrison","sequence":"first","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J L","family":"Wardian","sequence":"additional","affiliation":[{"name":"Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J A","family":"Sosnov","sequence":"additional","affiliation":[{"name":"Clinical Medicine, 375 MDOS, Scott AFB, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R S","family":"Kotwal","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F K","family":"Butler","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Z T","family":"Stockinger","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S A","family":"Shackelford","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J M","family":"Gurney","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M A","family":"Spott","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L N","family":"Finelli","sequence":"additional","affiliation":[{"name":"Armed Forces Medical Examiner System, Dover, Delaware, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E L","family":"Mazuchowski","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"},{"name":"Armed Forces Medical Examiner System, Dover, Delaware, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D J","family":"Smith","sequence":"additional","affiliation":[{"name":"Health Affairs, Falls Church, Virginia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J C","family":"Janak","sequence":"additional","affiliation":[{"name":"Joint Trauma System, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"key":"2025081307144302000_166.E.e47.1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1001\/jamasurg.2017.6105","article-title":"Comparison of military and civilian potentially preventable death methodologies: a systematic review","volume":"153","author":"Janak","year":"2018","journal-title":"JAMA Surgery"},{"key":"2025081307144302000_166.E.e47.2","unstructured":"National Academies of Sciences, Engineering, and Medicine . A National trauma care system: integrating Military and civilian trauma systems to achieve zero preventable deaths after injury. Washington, DC: The National Academies Press, 2016."},{"issue":"suppl_2","key":"2025081307144302000_166.E.e47.3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/milmed\/usy149","article-title":"Military preventable death conceptual framework: a systematic approach for reducing battlefield mortality","volume":"183","author":"Janak","year":"2018","journal-title":"Mil Med"},{"key":"2025081307144302000_166.E.e47.4","doi-asserted-by":"crossref","unstructured":"Beebe J . Rapid assessment process. Encyclopedia of Social Measurement, 2004: 285\u201391.","DOI":"10.1016\/B0-12-369398-5\/00562-4"},{"key":"2025081307144302000_166.E.e47.5","doi-asserted-by":"publisher","DOI":"10.17730\/humo.54.1.k84tv883mr2756l3"},{"key":"2025081307144302000_166.E.e47.6","unstructured":"Beebe J . Rapid assessment process: an introduction. Walnut Creek, CA: AltaMira Press, 2001."},{"key":"2025081307144302000_166.E.e47.7","unstructured":"DoD Instruction 5154.30 . \u201cArmed Forces Medical Examiner System (AFMES) Operations\u201d 2015;7:591\u2013603."},{"key":"2025081307144302000_166.E.e47.8","doi-asserted-by":"crossref","first-page":"591","DOI":"10.23907\/2017.050","article-title":"Beyond the forensic pathology investigation: improving Warfighter survivability","volume":"7","author":"Mazuchowski","year":"2017","journal-title":"Acad Forensic Pathol"},{"key":"2025081307144302000_166.E.e47.9","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/milmed\/161.suppl_1.3","article-title":"Tactical combat casualty care in special operations","volume":"161 Suppl","author":"Butler","year":"1996","journal-title":"Mil Med"},{"key":"2025081307144302000_166.E.e47.10","doi-asserted-by":"crossref","first-page":"e1563","DOI":"10.7205\/MILMED-D-16-00214","article-title":"Two decades of saving lives on the battlefield: tactical combat casualty care turns 20","volume":"182","author":"Butler","year":"2017","journal-title":"Mil Med"},{"issue":"Supplement","key":"2025081307144302000_166.E.e47.11","first-page":"S10","article-title":"Tactical combat casualty care: update 2009","volume":"69","author":"Butler","year":"2010","journal-title":"The Journal of Trauma: Injury, Infection, and Critical Care"},{"issue":"11 Suppl","key":"2025081307144302000_166.E.e47.12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7205\/MILMED.172.Supplement_1.1","article-title":"Tactical combat casualty care 2007: evolving concepts and battlefield experience","volume":"172","author":"Butler","year":"2007","journal-title":"Mil Med"},{"issue":"6 Suppl 5","key":"2025081307144302000_166.E.e47.13","doi-asserted-by":"crossref","first-page":"S395","DOI":"10.1097\/TA.0b013e3182754850","article-title":"Battlefield trauma care then and now: a decade of tactical combat casualty care","volume":"73","author":"Butler","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081307144302000_166.E.e47.14","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182755dcc"},{"key":"2025081307144302000_166.E.e47.15","doi-asserted-by":"crossref","first-page":"21","DOI":"10.55460\/ZGAF-INZU","article-title":"TCCC guidelines comprehensive review and update: TCCC guidelines change 16-03","volume":"17","author":"Montgomery","year":"2017","journal-title":"J Spec Oper Med"},{"key":"2025081307144302000_166.E.e47.16","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1097\/TA.0000000000001424","article-title":"Leadership lessons learned in tactical combat casualty care","volume":"82","author":"Butler","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081307144302000_166.E.e47.17","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1097\/TA.0000000000001428","article-title":"Leadership and a casualty response system for eliminating preventable death","volume":"82","author":"Kotwal","year":"2017","journal-title":"J Trauma Acute Care Surg"}],"container-title":["BMJ Military Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2019-001193","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T14:14:51Z","timestamp":1755094491000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2019-001193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,29]]},"references-count":17,"journal-issue":{"issue":"E","published-online":{"date-parts":[[2020,10,23]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/jramc-2019-001193"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2019-001193","relation":{},"ISSN":["2633-3767","2633-3775"],"issn-type":[{"type":"print","value":"2633-3767"},{"type":"electronic","value":"2633-3775"}],"subject":[],"published":{"date-parts":[[2019,4,29]]}}}