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A descriptive study of US Special Operations Command fatalities, 2001 to 2018

Kotwal, Russ S. MD, MPH; Mazuchowski, Edward L. MD, PhD; Stern, Caryn A. DrPH, MPH; Montgomery, Harold R. BA; Janak, Jud C. PhD; Howard, Jeffrey T. PhD; Butler, Frank K. MD; Holcomb, John B. MD; Eastridge, Brian J. MD; Gurney, Jennifer M. MD; Shackelford, Stacy A. MD

Journal of Trauma and Acute Care Surgery: September 2019 - Volume 87 - Issue 3 - p 645–657
doi: 10.1097/TA.0000000000002354

BACKGROUND Studies of fatalities from injury and disease guide prevention and treatment efforts for populations at risk. Findings can inform leadership and direct clinical practice guidelines, research, and personnel, training, and equipment requirements.

METHODS A retrospective review and descriptive analysis was conducted of United States Special Operations Command (USSOCOM) fatalities who died while performing duties from September 11, 2001, to September 10, 2018. Characteristics analyzed included subcommand, military activity, operational posture, and manner of death.

RESULTS Of 614 USSOCOM fatalities (median age, 30 years; male, 98.5%) the leading cause of death was injury (97.7%); specifically, multiple/blunt force injury (34.5%), blast injury (30.7%), gunshot wound (GSW; 30.3%), and other (4.5%). Most died outside the United States (87.1%), during combat operations (85.3%), in the prehospital environment (91.5%), and the same day of insult (90.4%). Most fatalities were with the US Army Special Operations Command (67.6%), followed by the Naval Special Warfare Command (16.0%), Air Force Special Operations Command (9.3%), and Marine Corps Forces Special Operations Command (7.2%). Of 54.6% who died of injuries incurred during mounted operations, most were on ground vehicles (53.7%), followed by rotary-wing (37.3%) and fixed-wing (9.0%) aircrafts. The manner of death was primarily homicide (66.0%) and accident (30.5%), followed by natural (2.1%), suicide (0.8%), and undetermined (0.7%). Specific homicide causes of death were GSW (43.7%), blast injury (42.2%), multiple/blunt force injury (13.8%), and other (0.2%). Specific accident causes of death were multiple/blunt force injury (80.7%), blast injury (6.4%), GSW (0.5%), and other (12.3%). Of accident fatalities with multiple/blunt force injury, the mechanism was mostly aircraft mishaps (62.9%), particularly rotary wing (68.4%).

CONCLUSION Most USSOCOM fatalities died abroad from injury in the prehospital setting. To improve survival from military activities worldwide, leaders must continue to optimize prehospital capability and develop strategies that rapidly connect patients to advanced resuscitative and surgical care.

LEVEL OF EVIDENCE Epidemiological, level IV; Therapeutic level IV.

From the Defense Health Agency, Combat Support-Joint Trauma System (R.S.K., E.L.M., C.A.S., H.R.M., J.C.J., J.T.H., F.K.B., J.M.G., S.A.S.), Joint Base San Antonio-Fort Sam Houston, Texas; Uniformed Services University (R.S.K., E.L.M., J.M.G., S.A.S.), Bethesda, Maryland; College of Medicine, Texas A&M University (R.S.K.), College Station, Texas; Armed Forces Medical Examiner System, Defense Health Agency (E.L.M.), Dover Air Force Base, Dover, Delaware; United States Army Institute of Surgical Research (J.M.G.), Joint Base San Antonio-Fort Sam Houston; Center for Translational Injury Research, The University of Texas Health Science Center (J.B.H.), Houston, Texas; Department of Surgery, The University of Texas Health Science Center, University of Texas (J.T.H., B.J.E.), San Antonio, Texas.

Submitted: March 7, 2019, Revised: April 15, 2019, Accepted: April 21, 2019, Published online: April 29, 2019.

Address for reprints: Russ S. Kotwal, MD, Department of Defense Joint Trauma System, 3698 Chambers Rd, Joint Base San Antonio-Fort Sam Houston, TX 78234; email:

The abstract of this study was presented at the 31st Annual Special Operations Medical Association Scientific Assembly, May 6–10, 2019, in Charlotte, North Carolina.

Online date: April 30, 2019

© 2019 Lippincott Williams & Wilkins, Inc.