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By Thomas A. Middleton, RN, EMT-I How technologies and techniques proving themselves in combat care may beneﬁt patients of civilian EMS On today’s modern battleﬁeld, medical care has made remarkable strides in saving the lives of the wounded. Soldiers and Marines who would have perished in yesterday’s wars are returning home in spite of devastating injuries. Our troops are equipped to stabilize their own injuries and those of their buddies, even in the absence of medical personnel. Medics and corpsmen are armed with advances in technology as they emerge, and our experience helps set new standards of trauma care. Front-loading deﬁnitive medical care at the point of injury is the gold standard of perfusion. Does it make sense to lie makes obvious sense. The patient’s own well-oxygenated still on the battleﬁeld, bleeding and yelling “Medic!” when the blood, circulating in a system of relatively intact blood vessels, means exist for the injured to stop his own bleeding? Does www.emsresponder.com EMS OCTOBER 2009 57 it make sense for the casualty with a and signiﬁcant hemorrhage? Does it patched-up circulatory system to arrive make sense to apply a tourniquet before at the hospital without an airway, opening an airway? Does A always suffering from irreversible hypoxic have to come before B and C? Like any brain injury? question worth pondering, the answer is usually, “It depends.” Logic says A VS. B, EXCEPT AFTER without air in it, the circulating blood C won’t do any good. True…but without Of the many advances in battleﬁeld blood to carry it, the inhaled oxygen medicine, some of the most beneﬁcial won’t do any good either. It takes both. are also the simplest. Consider the In the case of signiﬁcant penetrating tourniquet. Once we apply it, we no extremity trauma, especially in the longer consider an extremity lost. We prehospital setting, where blood trans- have learned that as long as the tourni- fusions are not readily available, the quet is removed in the next few hours, patient really needs to keep their own the limb will likely make a full recovery. blood on board. If we consider bleeding Along with this change in thinking, the control only in the context of our tradi- military has also adopted newer tour- tional civilian approach (direct pres- niquets, manufactured with a sturdy sure, elevation, pressure point, almost nylon strap and an attached windlass never a tourniquet), it might indeed instead of a stick. Today, every soldier take so long that the patient suffo- is issued this one-handed tourniquet to cates from lack of a deﬁnitive airway. apply to their own injured limbs, stop- Fortunately, penetrating trauma with ping the loss of blood before signiﬁcant signiﬁcant hemorrhage is uncommon hemorrhage occurs. These are much in the civilian trauma patient, and quicker and simpler to apply than when it occurs, our approach is often yesterday’s homemade strip of cloth deﬁned by the simultaneous efforts of and a stick foraged from the woods. more than one EMT. In this arrange- But what about the simultaneous ment, one rescuer might well be spared presentation of airway compromise to do nothing but provide direct pres- New Technologies for Old Injuries? There is much debate about whether the use of our wounded warriors as unw
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