The U.S. military expects that military operations in the near future will more frequently resemble activities of the Special Operations forces (Secretary of Defense, 1999). That is, conflicts will develop quickly and troops will be delivered to the battlefield on short notice, as compared with prior wars that involved large numbers of ground troops engaged in prolonged conflicts over large areas. Because of the rapid deployment, it is unlikely that combatants will be chronically dehydrated or malnourished. However, engagements may take place in desert or arctic environments as well as in jungles or mountainous regions. Precipitation, humidity, altitude, and extremes of hot and cold can all affect the condition of the combat casualty.
Although many of the approaches to trauma care evolved from clinical research in the civilian sector, there are substantial differences between the injured combatant and the injured civilian. Civilian trauma patients encompass a broad spectrum of age, weight, coexisting disease, and cardiovascular conditioning. In addition, ethanol or illicit drug intoxication is a frequent component of civilian trauma. In contrast, military combatants are uniformly young, healthy, and physically fit, and ethanol or drug intoxication is a rare occurrence on the battlefield. As described in Chapter 1, battlefield injuries differ from those in the civilian sector in that civilian injuries often involve blunt trauma, whereas penetrating wounds are more common on the battlefield. Penetrating injuries in civilians are the result of bullets or knives, whereas penetrating battlefield wounds are usually due to shrapnel. Finally, civilian trauma is commonly associated with very rapid transport to an advanced medical facility (emergency department or trauma center), whereas military medical transport is often delayed for the wounded combatant.
Fluid therapy and other first-line treatments also differ between military and civilian environments. Battlefield care is characterized by limited resources, limited expertise, and delayed transport to medical facilities. Initial combat care is often provided by a medic or other combatant who carries limited medical supplies in addition to weaponry. Approaches to battlefield care and fluid resuscitation must be designed for the remarkably challenging conditions that face the first responders who care for casualties in far-forward deployment areas.
Because of the likely locations of future conflicts, immediate evacuation by air may be difficult or impossible. As a result, initial and even ongoing treatment of casualties may be significantly extended. As mentioned above, lifesaving medical treatment may well come from a fellow combatant or a medic—both of whom are included in the term "first responder." First responders are likely to be young, inexperienced in combat, and without medical training or experience.