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Cross-sectional analysis of Dutch repatriated service members from southern Afghanistan (2003-2014).

BACKGROUND
A systematic analysis of the complete medical support organization of the Dutch Armed Forces regarding repatriated service members from Afghanistan has not been performed so far.


METHODS
All information were collated in a specifically designed electronic database and gathered from the archive of the Central Military Hospital for all Dutch service members receiving treatment for wounds or diseases sustained in the Afghan theater from July 2003 till January 2014.


RESULTS
Traumatic injuries were the main cause (63%, 141/223) of repatriation, and improvised explosive devices the major (67%, 60/89) mechanism of injury in the battle casualty group. The mean time between injury and medical evacuation from Afghanistan was 8 days, and this was reduced to 3.6 days in case of polytrauma casualties (ISS > 15).


CONCLUSIONS
Sixty percent of all Dutch medical evacuations from Afghanistan were not directly related to combat operations. A standard medical examination/endurance test in the predeployment phase could be useful as screening tool in reduction of the disease nonbattle injury casualty rate. Shorter transport intervals might improve morbidity and mortality of casualties, a timeframe of 48 to 72 hours for receiving definitive treatment seems feasible. Further research is necessary to identify delay factors and possible improvements in the medical support organization.