Combat Casualty Management

Abstract

Contemporary conflicts in Iraq and Afghanistan have produced substantial advances in the care of those injured in combat. Foremost has been the establishment of a seamless, comprehensive system for the management of casualties from the point of wounding to definitive care and rehabilitation – the continuum of care. Within this system, considerable improvements have been made in care at the point of wounding through tactical combat casualty care protocols, which include increased reliance upon self and buddy care, control of exsanguinating hemorrhage using tourniquets and hemostatic dressings, establishing and maintaining a patent airway, ensuring that the wounded can breathe, and removing the patient rapidly from harm’s way. Hypovolemic shock is no longer managed by large-volume fluid replacement. Where rapid evacuation by helicopter to surgical care is problematic, the system can be reinforced by the deployment of field teams, which are small units capable of life-saving resuscitative procedures. Surgery is usually phased at every level, aimed at stabilizing the patient for early evacuation and rapid transition to rehabilitation. To achieve this, air forces have developed the capability to manage critically ill patients over long journeys of many hours.

The overarching lesson learned is that medical training for combat casualty care must be military-centric rather than based upon civilian emergency medical services protocols. The need to train all combat troops in tactical combat casualty care (TC3) places a heavy demand on training resources, and there is an urgent need to invest considerable resources in innovative technology, such as simulators designed specifically for TC3. The second lesson, yet to be clearly articulated, is how TC3 can be adapted and adopted for use in civilian prehospital trauma care during major incidents.