Lessons From the BATTLEFIELD by ProQuest

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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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