Nice article on battlefield Prehospital care

[mwbeah]

In a previous thread, the prehospital area was discuss. I thought I would provide this article I found FYI.

Hope you like it,

Mike

Improving care at the point of wounding is the best medicine. The process has to start long before soldiers ever see the battlefield and the first step is training and then more training.

By Retired Lieutenant Colonel Donald L. Parsons, PA-C

Soldiers continue to die on today's battlefield just as they did during the Civil War. Medical care has progressed significantly since that time, but we have not been able to limit the number of soldiers who die on the battlefield. We know that 90 percent of all combat deaths occur before a casualty reaches a definitive care facility. While we have spent a great deal of money improving our medical capabilities at echelon II and above, little has been done to improve medical care at the point of wounding. If a casualty survives long enough to reach a definitive care facility, his chances of survival are excellent.

The linear battlefield limits the number of trained medical personnel attached to maneuver elements. We must fill the gap with some type of medical capability at the individual soldier level. I suggest a three-tiered level of pre-hospital care and that a proponent for this care be assigned in order to improve the survivability of the soldier in combat.

Causes of Death on the Battlefield

The following are the major causes death on the battlefield:

* Penetrating head trauma - 31 percent

* Uncorrectable torso trauma - 25 percent

* Potentially correctable torso trauma - 10 percent

* Exsanguination from extremity wounds-9 percent

* Tension pneumothorax - 5 percent

* Airway problems - 1 percent

Many of these injuries are not survivable, even with a hospital located at the point of injury. However, soldiers with injuries such as extremity hemorrhages, penetrating chest wounds with the development of a tension pneumothorax and compromised airways can be saved. In Vietnam approximately 2,500 soldiers died on the battlefield because they bled to death, and the only injuries these individuals had were extremity wounds. If a soldier sustains an airway problem or a major arterial hemorrhage, he has only a few minutes to get medical help before it is too late.

The three-tiered approach would help provide basic lifesaving skills at the point of wounding and could possibly lower the battlefield death rate by up to 15 percent.

Tier One It is conceivable that a soldier may be wounded while no combat lifesaver (CLS) or medic is available, or the tactical situation may prevent him/him or her from attending to the casualty. By providing training (basic tactical medicine principles) and equipment to the individual soldier level, care would be available at the point of wounding on the battlefield. Training should teach soldiers how to:

* Conduct a rapid patient survey (basic ABCs).

* Stop bleeding using an emergency trauma bandage and/or tourniquet.

* Treat life-threatening penetrating chest wounds with an occlusive dressing and perform a needle chest decompression if necessary. * Insert a nasopharyngeal airway in an unconscious casualty and place the casualty in the recovery position.

There would also be training on additional first-aid skills, but the above topics are the primary lifesaving skills to be emphasized prior to any combat deployment. Every soldier in the Army would be trained on these skills, which is part of the Army chief-of-staff's "Warrior Core Skills."

Tier Two

The CLS would provide the second tier of care. In addition to the above tasks, the CLS would be able to insert an intravenous catheter or saline lock and provide hypotensive fluid resuscitation for casualties on the battlefield, as well as perform other first-aid procedures. The CLS would have more supplies and equipment to accomplish these lifesaving tasks, and would augment the self-aid/buddy-aid already provided. The CLS training would also be based on tactical medicine principles.

Tier Three

The 91W combat medics would provide the third tier of pre-hospital care. They would be trained in initial care and resuscitation at more advanced levels based on tactical combat casualty care principles. They would have more medical supplies and equipment and provide more expertise on caring for combat casualties.

Lifesaving Kit

Proper equipment would be necessary at each level of care. This would require taking a new look at the individual first-aid kit. The kit would need to consist of a tourniquet, an emergency trauma dressing (instead of the old battle dressing), a roll of Kerlix, a nasopharyngeal airway and a 10- to 14-gauge needle and catheter unit. This equipment, along with individual soldier skills, would provide the basis for self-aid and buddy-aid. Individual lifesaving skills should be updated on a schedule similar to basic rifle marksmanship qualification or common tasks training.

Combat Lifesaver

CLS training would continue to be conducted by a unit's organic medical section. Units without organic medical support would contact division medical assets, such as the division surgeon's office or the local medical treatment facility. Although combat lifesavers have morphed into junior medics over the past several years, they are primarily combatants who have received additional lifesaving training and are used as the tactical situation allows. CLS tasks would mirror self-aid with the addition of hypotensive fluid resuscitation skills. Their medical equipment set would be modified to reflect the equipment needed to support their lifesaving skills.

Combat Medic

Combat medic training is conducted in the 16-week 91W program at Fort Sam Houston, TX. These individuals are more extensively trained and certified to assist in the training of the two lower level tiers of care. On the battlefield, the combat medic is also the re-supply point for the CLS. The combat medic and the combat lifesaver are trained specifically in tactical medicine principles that are different from civilian-based medical training.

Casualty Scenarios

Casualty play needs to be integrated into all training scenarios. To train with no simulated casualties is tantamount to saying we will not sustain any casualties when we go to war. If leaders are not trained to expect and plan for casualties, they will have problems during actual combat. Casualty scenarios in combat usually involve both a medical problem and a tactical problem to ensure the best outcome for both the soldier and the mission.

Training Proponent

The Army Medical Department's leadership needs to identify a proponent for pre-hospital care. The Department of Combat Medic Training at Fort Sam Houston is the logical choice. The department has the responsibility to train combat medics in pre-hospital lifesaving skills under battlefield conditions. The training should extend to the combat lifesaver and the individual soldier in basic training.

The training for these tasks would be similar at each level of pre-hospital care. The equipment should be standardized for each level of care as well.

Saving Soldiers

Pre-hospital care continues to be the most important aspect of battlefield medicine. The majority of soldiers die before they arrive at a definitive care facility. There is no central focus for this level of care in the Army today. The time has come to put such a plan into action.

By combining resources and consolidating training, point of wounding care would improve, as would the survival rate of the soldier in combat. By establishing different tiers of care and assigning a proponent for this care, the training, equipment and philosophy for battlefield medicine will become more focused on the essentials of lifesaving care for the individual soldier. Retired Lieutenant Colonel Donald L. Parsons, PA-C, is with the Department of Combat Medic Training, Fort Sam Houston, TX.