Effects of Early Prehospital Life Support to War Injured: The Battle of Jalalabad, Afghanistan

OBJECTIVE: To study the effects of early, advanced prehospital life support on the survival rate of war casualties during the battle of Jalalabad, Afghanistan from 1989-1992. METHOD: The outcomes of simple trauma care administered from 1989-1990 were compared to the outcomes of advanced trauma care administered from 1991-1992 in the combat zone. The outcomes were measured by the number of deaths at admission to the referral surgical hospitals in Pakistan. RESULTS: A total of 3,890 war casualties were treated in the combat zone by paramedics, and were evacuated through light, forward, field clinics to surgical hospitals in Pakistan. Advanced trauma care that was administered in the combat zone reduced the prehospital mortality rate from 26.1% to 13.6% (95% CI for difference = 9.7-15.4%). CONCLUSION: In scenarios with protracted evacuation, early and advanced trauma care should be included in the chain of survival. Local paramedics can provide such trauma care with a minimum of resources.