Care for combat casualties is different in many ways than care for trauma casualties in civilian medical systems. Even the term casualty is used differently. Whereas “casualty” typically refers to traumatic death in the civilian system, the word refers to combat-related injury in the military environment. Because many health care providers working for the military or other governmental agencies have been trained in civilian hospital environments, they often are unprepared and ill-equipped for treating combat casualties. Many of the trauma management principles that we practice in civilian medical systems do apply; however, there are significant deviations from the standards established for trauma care in civilian facilities. The intent of this chapter is to highlight the important differences between civilian and combat trauma management to better prepare the physician who will be caring for combat casualties. This chapter does not replace more comprehensive references published on this topic.


The American College of Surgeons has developed the Advanced Trauma Life Support (ATLS) Course as a systematic approach to the assessment and management of trauma patients; however, these treatment methods and approaches to trauma care are best applied in a hospital setting, not necessarily in a combat setting. In the latter, it is likely that you may be the only provider tending to a casualty or multiple casualties. How will you manage a casualty without the assistance of ancillary staff? What should you do differently without ready access to a trauma surgical team? How will you manage this casualty in the dirt, at night, while engaged with enemy forces? Simple tasks such as obtaining vital signs or auscultating lung sounds become significantly more challenging. This chapter is not a comprehensive guide to combat casualty management (many volumes have already been dedicated to this topic), and multihour casualty care courses exist that the reader should consider. Table 298.2-1 lists the echelons of care for combat casualties.

Table Graphic Jump Location
Table 298.2-1 Military Echelons of Care 

Penetrating injuries from both shell fragments and bullets account for 90% of combat injuries. Extremity injuries are by far the most common anatomic location of combat injuries. From World War I through Somalia, head and neck injuries accounted for 4% to 24% of injuries; thoracic injuries from 4% to 15%, abdominal injuries from 2% to 20%; and extremity injuries from 50% to 75%.1 Exsanguination results in approximately 50% ...

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