Fluid Resuscitation State of the Science for Treating Combat Casualties and Civilian Injuries (1999) / Chapter Skim
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5 Protocols of Care at the Site of Injury
5 Protocols of Care at the Site of Injury
Pages 97-108
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From page 97... ...
The U.S. military expects that future battles will be fought by smaller groups of combatants, over shorter time intervals, and with fewer casualties at any point in time (Secretary of Defense, 1999~.
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From page 98... ...
Limits of Battlefield Care for the Injured Combatant 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.
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From page 99... ...
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.
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From page 100... ...
The diagnosis of a tension pneumothorax can be strengthened by visually identifying other signs, but this is not essential and may not be possible at night or while under fire. Although the trained responder will likely be inexperienced with needle thoracostomy, any additional trauma caused by this intervention is not expected to worsen the combat casualty significantly, whether or not a tension pneumothorax is present (Cameron et al., 1993~.
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From page 102... ...
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)
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From page 103... ...
Both the composition and amount of the initial bolus are based on clinical trials outlined in Chapter 3. The bag containing hypertonic saline would be placed under low pressure or accompanied by a simple, sturdy pumping device that could be mechanical or electric.
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From page 104... ...
Its use can rapidly be taught to lay personnel, and the success rate maintained at a high level (Davies et al., 1990; Tolley et al., 1992; Walker et al., 1993~. Recent work has indicated that after 5 minutes of training, lay personnel trained to use the intubating LMA on mannequins had a 90 percent success rate, a rate maintained over a period of at least 1 week (Richard Levitan, personal communication)
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From page 105... ...
The committee concurs with Butler and colleagues (1996) , who recommended that any combatant with severe progressive respiratory distress resulting from a unilateral penetrating chest wound should be considered to have a tension pneumothorax.
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From page 106... ...
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. Monitoring 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~.
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From page 107... ...
PROTOCOLS OF CARE A T THE SITE OF INJUR Y 107 These seem more suited for secondary evacuation and transport. At this time, it is unclear whether having these litters on the battlefield would be realistic.
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