Evaluating the Military Medical Evacuation Chain: Need for Expeditious Evacuation Out of Theater?

An important factor within the military medical logistical chain is the capability of expeditious evacuation from point of injury, through a Medical Treatment Facility, to the country of residence where highest level of care can be provided. Although many factors can relate to patient outcome, the evaluation of the medical evacuation chain related to long-term patient outcome can be important for investigating possibilities for performance improvement in this domain. This article aims to provide a means to evaluate the quality of care of the medical evacuation chain. Repatriated service members from the Afghan theater between 2004 and 2014 were invited to participate in a survey concerning functional outcome and quality of life using Lower Extremity Functional Scale, Short Form health survey 36, and EuroQol-6D questionnaires. Possible associations between these outcomes were analyzed in respect to duration of medical evacuation from point of injury to arrival in the Dutch military hospital. The duration was dichotomized into within and after 72 hours. Ordinal regression was used to analyze a possible association with duration as a continuous variable. Sixty percent (28/47) of battle casualties arrived in The Netherlands within 72 hours. For the nonbattle injury cohort this was 30% (7/23). Of those who became ill, 18% (5/28) was evacuated in 72 hours. No significant independent associations between interval duration and measured outcomes were found. Repatriated battle casualties had lower outcome scores compared to the disease nonbattle injured service members. Significant differences in functional outcome and quality of life with respect to evacuation duration were not found. Specialized tactical evacuation and en route care capability during strategic evacuation contributed to relative high standards of care. Combined with our results, this could implicate that delivery of the right care to the right patient at the right time is a justifiable paradigm. The main focus of the medical support organization is to offer the highest level of care per echelon as soon as possible in conjunction with facilitating maximum social support through expeditious evacuation out of theater. Further research using semistructured interviews among the direct circle around battle casualties, including caregivers, is needed to provide insight into these complex matters.