Often, they will need to initiate immediate care while under fire, returning fire, or otherwise consumed by the chaos and confusion of battle.

Appropriate fluids and fluid protocols will play an integral part in the preservation of life until the wounded can be evacuated to a site where advanced medical expertise is available. Because the military first responder is severely limited in what he or she can carry into the field, approaches to resuscitation as well as other therapies must be streamlined and efficient. Supplies and equipment must be of low weight and small volume. Initial treatment protocols must consider both the needs of the average wounded combatant and the limitations of the battlefield environment.

Resuscitation Needs of the Injured Combatant on the Battlefield

For the reasons stated above, initial treatment protocols must be simple and should focus on the most critical needs of the typical combat casualty. Those needs are (1) establishing or ensuring an adequate airway and breathing, (2) controlling external hemorrhage, and (3) fluid resuscitation of hypovolemia and shock. In addition, the first responder must initiate and facilitate rapid evacuation to deliver live casualties to organized medical care behind the lines of battle. Critical tasks for resuscitative care include:

  • establishment of an adequate airway,
  • control of massive hemorrhage,
  • circulatory support by intravascular fluid replacement,
  • detection and treatment of hemo- or pneumothorax (including tension pneumothorax), and
  • immobilization of fractures.
Immediate Versus Delayed Fluid Resuscitation

Regarding the unresolved issue of immediate versus delayed fluid resuscitation, Bickell and colleagues (1994) reported interesting findings in an inner city served by an efficient paramedic system with short times of transport to definitive care. These investigators concluded that the group of patients in whom fluid resuscitation was delayed had a lower mortality rate. Because the transport times were far shorter than they would be in the battlefield, it is not clear that their findings would apply to the military setting. In addition, the methodology of that work has been criticized on the basis of the lack of comparability of the two treatment groups, bias in patient selection, the small difference in the actual amounts of fluids that the two groups received in the prehospital setting, and the differences in the times to operative intervention. In view of the above and the likely delays to definitive therapy in the combat environment, immediate fluid resuscitation seems more appropriate for wounded combatants.



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