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KEY POINTS

KEY POINTS

  1. Military personnel treat injuries which are similar to the civilian population as well as those specific to war and combat.

  2. Multiple factors influence the five levels of aeromedical evacuation. Patients are moved through the system as quickly and safely as possible with consideration for combat activities and terrain.

  3. It is important to understand the mechanism of injury. Projectile injuries are influenced by kinetic energy (KE), depth of penetration, and yaw.

  4. Explosive trauma, resulting in thermal, blast and/or ballistic injury, is the most common mechanism of military-related injury in current conflicts.

  5. In patients with significant hemorrhage, massive transfusion protocols and viscoelastic coagulation testing guided resuscitation may be helpful. Fresh whole blood transfusion can be an important component in austere conditions.

  6. Nuclear, biological, and chemical warfare can affect a massive number of individuals. Exposure prevention and decontamination are paramount. Supportive care and exposure-specific management then follow based on patient-specific presentation and factors.

Conflicts in far-reaching and diverse areas of the world have resulted in a myriad of traumatic injuries which health care providers are tasked to treat. Some military injuries are comparable to civilian traumatic injuries, while others are unique to wartime/conflict operations. Unfortunately, with the current state of terrorism, the line between the two is becoming more blurred, making it all the more important for all providers to be aware of what classically have been thought of as “military-related injuries.” In addition to the severity and pattern of injuries, the conflict environment itself adds an additional complexity to providing medical care in these situations. This chapter will provide an overview of the injuries traditionally associated with military operations, as well as highlight operational considerations. “Lessons learned” from our military colleagues can be lifesaving when applied to disaster situations no matter the location or specific circumstance.

While many surgical advances have been, and are being made, because of the vast experiences of military wartime trauma, many civilian injuries are treated in a similar fashion as military their counterparts. The sheer number of seriously injured in recent conflicts has allowed the military to further evidence-based transfusion practices. For example, the numerous multiple-injured military personnel have allowed for improved mortality in massive transfusion with the creation of 1:1:1 ratio protocols1 and the addition of tranexamic acid.2 In the end, however, these strategies are not significantly different from the massive transfusion protocols in place in civilian institutions. Similarly, splenic lacerations, whether sustained from a car crash in Missouri or an improvised explosive device (IED) detonating under a tank in Afghanistan, are treated the same. Furthermore, while traumatic brain injury (TBI) may be seen in an increased frequency in current military conflicts, its management is also comparable to its stateside counterpart. The military may be more in tune to the effects of repeat concussions, but the underlying management is the same. This chapter will highlight instances where military trauma varies from civilian trauma.

AEROMEDICAL ...

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