The principles of military medical care are applicable to care in civilian mass casualties, in remote settings, for tactical medicine, and in bioterrorism incidents.
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? Chapter 7, “Bomb, Blast, and Crush Injuries,” Chapter 8, “Chemical Disasters,” and Chapter 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 |Favorite Table|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; special operations forces medical elements (SOFME)
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 casualty treatment requires a properly supplied aid bag. Mission analysis, phases of care, and potential worst-case scenarios guide needed equipment. Pack the aid bag with attention to weight and volume; overpacking creates challenges locating supplies. Supplies with multiple purposes reduce weight and volume. Bundling simplifies tasks (i.e., bundle hemostatic dressings with other wound packing material and compression bandages).
Tables 302-2 and 302-3 provide example packing lists. Building multiple, mission-specific bags or packaging extra bundled items assists with modification of bags and resupply. Every soldier is outfitted with an individual first aid kit (Table 302-4). Train on your personal equipment, maintain it, and pack smartly to ensure easy access to critical items.
TABLE 302-2Trauma Aid Bag Suggested Packing List |Favorite Table|Download (.pdf) TABLE 302-2 Trauma Aid Bag Suggested Packing List
Gauze or packed gauze
Trauma dressing(s) 4 or 6 inch
Nasopharyngeal airway(s) with lubricant
14- or 10-gauge, 3.5-inch decompression needle(s)
Finger pulse oximetry
IV starter kit(s) with saline lock
Intraosseous device (peripheral and/or sternal)
Sodium chloride flush(es) (10 or 5 mL)
IV administration tubing (10 gtt)
IV fluid for blood administration priming and carrier fluid
Pressure infuser device
Junctional hemorrhage device (consider one that also works as pelvic splint)
Cravat or elastic bandage(s)
Tape, silk 2 inches