Conclusions and Recommendations

The greatest opportunity for reducing the rate of mortality among combat casualties occurs on the battlefield. Unfortunately, the battlefields of the future may be less accessible than those of the past. Because conflicts in high-density urban or remote locations may lead to delays in evacuation by air, the committee concluded that immediate and subsequent ongoing treatment of casualties in far-forward areas should be improved. The committee's recommendations address approaches to the targets of injury, protocols for treatment in the field, and methods of evaluating and improving these protocols in the future.

Training First Responders

Initial care can be improved substantially by training more combatants to administer lifesaving measures to their fellow soldiers. The Israeli army trains half of its combatants to be medics. Although this may be unrealistic for the U.S. military, small mobile combat units should include a significant number of individuals with emergency medical training to provide the care that is outlined below. Larger units would require a smaller percentage of combatants so trained. Today there are excellent courses—such as the Prehospital Trauma Life Support (PHTLS) advanced trauma life-support course for prehospital providers developed by the American College of Surgeons (McSwain et al., 1994), the Basic Trauma Life Support (BTLS) advanced trauma life support course for prehospital providers developed by the American College of Emergency Physicians (ACEP) (Campbell, 1996), and the British Battlefield Advanced Trauma Life Support (BATLS) course—which could be used as a structure on which to base such training. The signs and symptoms of shock or tension pneumothorax, and all of the medical interventions recommended below, are taught in these courses. In view of the marked differences between the battlefield conditions and the civilian environment, the committee believes that it would be valuable to design a modified ATLS® course (Military Trauma Life Support) to train significant numbers of military first responders who could supplement the efforts of corpsmen and medics.

Recommendation 5.1 The number of trained first responders in the combat environment should be increased through development of a Military Trauma Life Support course.

Available Approaches for Treatment of Injury

The injuries that are responsible for the majority of fatalities and that are potentially treatable are exsanguinating hemorrhage, airway compromise, and tension pneumothorax (Bellamy, 1984, 1987b). The resuscitation and maintenance of life in a combat casualty (or civilian trauma victim) requires multiple



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