Care for combat casualties is somewhat different from care for civilian trauma casualties, even though many civilian trauma management principles apply, and conversely, some military techniques have been adapted to the civilian sector. The principles of military medical care are applicable to care in civilian mass casualties, in remote settings, for tactical medicine, and in bioterrorism incidents. Civilian emergency medicine should regularly follow military medical advances and adapt as appropriate.
Advanced trauma life support approaches are well applied in a hospital setting, but in combat, how do you function without ancillary staff? What do you do without ready access to a surgical team? How will you manage in the dirt, at night, while engaged with enemy forces? Simple tasks such as obtaining vital signs or auscultating lung sounds are very challenging. Chapters 7, "Bomb, Blast, and Crush Injuries," 8, "Chemical Disasters" and 9, "Bioterrorism," discuss many conditions relevant to the combat situation. Table 302-1 lists the roles of medical care for combat casualties.
TABLE 302-1Military Roles of Medical Care ||Download (.pdf) TABLE 302-1 Military Roles of Medical Care
|Role 1: self/buddy aid, nonmedical unit level combat lifesaver, medic or corpsman aid up to battalion aid station |
|Role 2: brigade or division level, medical companies/battalions, support battalions, forward surgical teams, PRBCs, limited x-ray and lab capability, damage control care for evacuation to next role |
|Role 3: corps level, combat support hospitals, in-theater military treatment facility (MTF), comprehensive stabilizing care for evacuation out of theater |
|Role 4: definitive care, ultimate treatment capability, full rehabilitative care, tertiary care MTF, typically located in continental United States or comparable out-of-theater safe havens |
Combat situations require a properly supplied aid bag. A blood pressure cuff and central-line kit have little use on the battlefield. Pack one item that serves multiple purposes, rather than two or three items with limited applications. For example, a cravat can be used as a standard field dressing, pressure dressing, or tourniquet or to hang an IV bag, cover a face as a dust mask, protect against sun exposure on head or neck, filter parasites from water, or even clean weapons.
See Tables 302-2 and 302-3 for examples packing list for aid bags. Not all items will be needed or packed in one bag; the nature of the mission, duration, terrain, weather, and other factors guide the packing list. Consider maintaining two or more different packing lists for different purposes (i.e., one for battle injuries and one for nonbattle injuries).
TABLE 302-2Trauma Pack Suggested Packing List ||Download (.pdf) TABLE 302-2 Trauma Pack Suggested Packing List
|Combat Application Tourniquet (Composite Resources, Rock Hill, SC) or equivalent (× 4–5) or Delfi EMT tourniquet (Delfi Medical Innovations, Inc., Vancouver, Canada) (× ...|