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In addition to the treatment protocols and training recommendations made above, the committee identified some additional considerations. These include the need for prompt evacuation and the development and use of miniaturized physiological monitoring equipment.
Prompt Aeromedical Evacuation
The United States and many parts of Europe have seen the development of extensive sophisticated civilian aeromedical emergency care and helicopter evacuation systems (Mabry et al., 1993). In some settings, trauma patients are no more than 5 minutes from the closest aeromedical units. These systems have treated and evacuated thousands of trauma victims and have saved countless lives (DeLorenzo, 1997; Gearhart et al., 1997; Hotvedt et al., 1996; Young et al., 1998; Zalstein and Cameron, 1997). Unless conditions are totally prohibitive, the committee encourages the military to emulate the civilian sector in this regard. The long evacuation times from the battlefield that occurred as recently as Operation Desert Storm, deserve substantial attention and remediation. Resuscitation of casualties in the field will never replace definitive surgical intervention, and if mortality is to be reduced in the future, aggressive field resuscitation must be followed immediately by aggressive aeromedical evacuation.
Recommendation 5.4 If accessible, all severely injured battlefield casualties should be evacuated to a front-line high-echelon care site in less than 1 hour.
The committee endorses the use of miniaturized physiological monitoring equipment as well as the continued research into its further development (Gopinath et al., 1995; Robertson et al., 1995, 1997). These devices could provide passive monitoring of the most critical vital signs of all combatants. Specific modalities that should be monitored are:
systolic blood pressure,
end tidal CO2.
Other potentially useful monitoring systems are under development. These include cardiac output monitors and the self-contained monitoring medical litter.