Another 1.7 percent of injured Rangers died of their wounds at the hospital -- again, lower than the 5.8 percent of other injured military personnel who died at the hospital.
The difference in survival can't be explained by less severe injuries. Injured Rangers actually had a lower return-to-duty rate (back on the job within 72 hours) than the wider military population, suggesting that Ranger injuries may have actually been more severe, according to the study.
"This kind of information is exactly the kind of evidence we wanted to see," said Dr. Peter Rhee, chief of trauma at University Medical Center in Tucson who is on the Defense Health Board, an advisory committee that oversees the TCCC.
The study is published in the Aug. 15 online issue of the Archives of Surgery.
TCCC has three objectives: treat the patient, prevent additional casualties, and complete the mission. The guidelines focus on preventing the three major causes of battlefield deaths: severe bleeding due to a loss of limb or other injury; tension pneumothorax (lack of oxygen and low blood pressure from a collapsed lung); and airway obstruction.
TCCC emerged from studies of casualties in previous wars, during which combat casualty care followed the civilian strategy -- physicians and medics were responsible for delivering care on the battlefield, Kotwal said. But conflicts in Iraq and Somalia in the early 1990s showed that there were "profound medical differences between civilians and military environments," according to the article.
Among them: care often had to be delivered in the dark of night, in extremes of temperature, while being fired at, and with only a handful of physicians or physician assistants attached to any regiments, sometimes not enough to get to everyone who needed treatment quickly enough, Kotwal said.
TCCC called for dramatic changes, said Rhee, who had a 24-year military career and who treated the victims of the January shooti
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