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Prehospital Medical Documentation in the Joint Theater Trauma Registry: A Retrospective Study

Therien, Sean P. DSc, PA-C; Nesbitt, Michael E. DSc, PA-C; Duran-Stanton, Amelia M. PhD, PA-C; Gerhardt, Robert T. MD, MPH, FACEP

Journal of Trauma and Acute Care Surgery: July 2011 - Volume 71 - Issue 1 - p S103-S108
doi: 10.1097/TA.0b013e3182218fd7
Original Article

Background: Prehospital care of combat casualties is a critical phase of emergency medical practice on the battlefield. The Joint Theater Trauma Registry (JTTR) was developed to standardize a system of data collection for combat casualty care; however, the degree of population and granularity of prehospital data were unknown.

Methods: This is a retrospective comparative study of all US military personnel who sustained battle injuries in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). The JTTR was queried for all US military battle casualties from OIF and OEF entered between January 2002 and July 2009 containing any data entered into the prefacility fields. Data were separated based on origination, OIF, or OEF. A comparative analysis was performed.

Results: During the period studied, 13,080 (66%) entries into the JTTR were recorded in the category of “Battle Injury” and met study inclusion criteria; 3,187 (24%) battle injury entries contained prehospital data (n = 3,187). The percentage of casualty records containing prehospital data were 18.6% for OEF and 25.4% for OIF (p < 0.01).

Conclusion: Both poor population of data points and poor granularity of prehospital data entered into the JTTR were observed. It appears that the volume and quality of reporting of role-I data were better for OIF than OEF for this study period. Further investigations into the obstacles to free flow of role-I casualty clinical data, and the means to mitigate this situation, are warranted.


From the Department of Emergency Medicine (S.P.T., M.E.N.), San Antonio Military Medical Center; Department of Orthopaedics and Rehabilitation (A.M.D.-S.), San Antonio Military Medical Center; and United States Army Institute of Surgical Research (R.T.G.), Fort Sam Houston, Texas.

Submitted for publication March 15, 2011.

Accepted for publication April 26, 2011.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or Department of Defense. This study was conducted under a protocol reviewed and approved by the US Army Medical Research and Materiel Command Institutional Review Board, and in accordance with the approved protocol.

Poster presented at Advanced Technology Applications for Combat Casualty Care, 2010, St. Pete Beach, Florida.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

Address for reprints: Sean P. Therien, DSc, PA-C, Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, 3851 Roger Brooke Dr, Fort Sam Houston, TX; email:

© 2011 Lippincott Williams & Wilkins, Inc.