from other regions were mobilized. Approximately 600 EMTs, 40 paramedics, and 15 physicians operating 97 basic life support (BLS) ambulances, 18 mobile intensive care vehicles, and 6 mobile first aid stations were mobilized. On site, the senior paramedic assumed command of all medical teams and established a triage and resuscitation center. Casualties were dispatched to hospitals after receiving immediate necessary life support on site. The distribution of casualties to hospitals was controlled by the medical commander on site and coordinated by the area dispatch center, given that citywide communications were still in operation. The ambulances had a turnover time of 30 minutes and evacuated 42 percent of the victims within the first hour and an additional 33 percent in the next hour. Avitzour and colleagues (2004) found that a unified medical command system facilitated rapid response on scene, full utilization of all medical resources, and early evacuation and triage of casualties to nearby hospitals. Because of the crowding caused at the scene, however, the authors concluded that the automatic dispatching of a large number of ambulances to the incident site was ill advised (Avitzour et al., 2004).

Additional Experience from the Iraq War

Experience from the Iraq war and previous conflicts has led to improvements in the delivery of health care services to wounded American soldiers. The U.S. military is now able to provide high levels of medical care to soldiers much more quickly than was possible in the past. Medical assets are closer to the front lines, and air medical capabilities have been improved (Miles, 2005). The U.S. Marine Corps and Navy introduced forward resuscitative surgery systems (FRSSs)—small, mobile trauma surgical teams of eight individuals (including two surgeons and support staff) designed to provide tactical surgical intervention for combat casualties in the forward area (Chambers et al., 2005). The units can erect a battlefield hospital with two operating tables and four ventilator-equipped beds in less than 1 hour (Gawande, 2004). New medical technologies, such as compact ultrasound and x-ray machines, generators that extract pure oxygen from the air, and computerized diagnostic equipment, have allowed the teams to provide fairly sophisticated care (Barnes et al., 2005). With these new surgical teams, the U.S. military’s strategy is to conduct damage control in the field (e.g., stopping bleeding and keeping patients warm), leaving definitive care to physicians at a hospital. Surgeons in the forward areas provide intermediate treatment, limiting surgery to 2 hours or less and sending the patient off to the next level of care.

Air medical evacuation procedures and equipment have improved to allow rapid transport of a critically injured solider. Because of those advances, the Air Force is transporting patients that never would have been



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