Frank K Butler

Military medical revolution: prehospital combat casualty care.

Abstract : In an effort to describe periods of profound change in military organization and practice, historians have given us a unique way to classify and describe these developments in a historical perspective. The concept describes advances in the art and practice of combat arms resulting in profound change as military revolutions accompanied by supporting revolutions in military affairs.

Military medical revolution: military trauma system.

Abstract : The development and advancement of trauma care has shown stepwise improvements for centuries owing to the interrelationship of civilian and military medical systems. With respect to trauma systems, the sophisticated civilian trauma system in the United States was born directly out of the successes and lessons learned from the Vietnam War. The American College of Surgeons (ACS) took the lead in advocacy for US trauma systems and, in 1972, published Early Care of the Injured Patient followed in 1976 by the first iteration of the Optimal Resources for Care of the Injured Patient. These documents outlined resources and practices to optimally care for injured patients across the continuum of care within the civilian spectrum. Numerous subsequent studies and analyses demonstrated that inclusive trauma centers and trauma assistance systems improve trauma outcomes. The development of combat casualty care capabilities during the current contingency operations has been a revolutionary story of successful adaptation and evolution, which has driven substantive improvements in the care of the battlefield casualty. This revolution was initiated in 2004 with the inception of a formal military trauma system, the Joint Trauma System (JTS). The purpose of the JTS was to develop a novel systematic and integrated approach to organize and coordinate combat casualty care. The basic principles of the trauma system were founded on four simple tenets: right patient, right place, right time, right care with the guiding vision that every soldier, sailor, airman, and marine injured in the battlefield will have the optimal chances of survival and functional recovery. In 2005, the JTS was originated within the US Army Institute of Surgical Research (USAISR) to support the overarching architecture of the entire continuum of combat casualty care from point of injury through rehabilitation.

Damage Control: Prehospital Care of the Patient With Vascular Injury

Abstract The recent decade of war experienced by the United States and its coalition partners has produced sweeping changes in the prehospital management of combat casualties. Collectively called Tactical Combat Casualty Care (TCCC), these new wartime prehospital trauma care strategies have centered on identification of the common causes of preventable battlefield mortality and the deployment of tailored management strategies directed at avoiding these deaths. Blood vessel trauma and disruption with subsequent hemorrhage remains the most common cause of preventable death in the combat wounded, so TCCC has a strong emphasis on the management of vascular injuries. Tourniquets are used aggressively on the battlefield to control extremity hemorrhage; hemostatic dressings, such as Combat Gauze, are used for compressible hemorrhage that occurs in anatomic locations not amenable to tourniquet use; new interventions for junctional hemorrhage control are being introduced; and tranexamic acid, an antifibrinolytic agent, is now being used to help improve survival in casualties with noncompressible hemorrhage. There is also an increased focus on the prevention and management of trauma-associated coagulopathy, on hypothermia prevention, and on the use of hypotensive resuscitation instead of large-volume crystalloid fluid resuscitation. Prehospital damage control resuscitation with 1u2009:u20091 plasma and packed red blood cell (PRBC) transfusion is used as soon as blood products are logistically feasible. Finally, evacuation strategies that call for more highly-skilled medical providers during transport and minimized transport time to definitive care have gained wide acceptance. The combination of these prehospital measures (with improved definitive care, advances in strategic evacuation, and improvements in personal protective equipment) have produced unprecedented casualty survival rates in the conflicts in Iraq and Afghanistan. Many of these strategies are also gaining increased acceptance in civilian trauma systems.