References

Alam HB, Chen Z, Jaskille A Application of a zeolite hemostatic agent achieves 100% survival in a lethal model of complex groin injury in Swine. J Trauma. 2004; 56:(5)974-83

Alam HB, Uy GB, Miller D Comparative analysis of hemostatic agents in a swine model of lethal groin injury. J Trauma. 2003; 54:(6)1077-82

Arishita GI, Vayer JS, Bellamy RF Cervical spine immobilization of penetrating neck wounds in a hostile environment. J Trauma. 1989; 29:(3)332-7

Aylwin CJ, Brohi K, Davies GD Prehospital and inhospital thoracostomy: indications and complications. Ann R Coll Surg Engl. 2008; 90:(1)54-7

Beekley AC, Sebesta JA, Blackbourne LH Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008; 64:(Suppl)S28-37

Bellamy RF The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984; 1499:55-62

Bellamy RFUS Army: Office of the Surgeon General; 2005

Belmont PJ, Schoenfeld AJ, Goodman G Epidemiology of combat wounds in Operation Iraqi Freedom and Operation Enduring Freedom: orthopaedic burden of disease. J Surg Orthop Adv. 2010; 19:(1)2-7

Bland SA, Lockey DJ, Davies GE Military perspective on the civilian response to the London bombings July 2005. J R Army Med Corps. 2006; 152:13-6

Brodie S, Hodgetts TJ, Ollerton J Tourniquet use in combat trauma: UK military experience. J R Army Med Corps. 2007; 153:(4)310-3

Brown MA, Daya MR, Worley JA Experience with chitosan dressings in a civilian EMS system.. J Emerg Med. 2009; 37:(1)1-7

Ambulance Trust Existing Commitment indicators.. 2009; http//tinyurl.com/4lg3prw

Carresi AL The 2004 Madrid train bombings: an analysis of prehospital management. Disasters. 2008; 32:(1)41-65

Clasper JC, Brown KV, Hill P Limb complications following prehospital tourniquet use. J R Army Med Corps. 2009; 155:(3)200-2

Cooper BR, Mahoney PF, Hodgetts TJ Intra-osseous access (EZ-IO) for resuscitation: UK military combat experience. J R Army Med Corps. 2007; 153:(4)314-6

Cushman JG, Pachter HL, Beaton HL Two New York City hospitals’ surgical response to the September 11, 2001, terrorist attack in New York City.. J Trauma. 2003; 54:(1)147-54

Davis PR, Rickards AC, Ollerton JE Determining the composition and benefit of the prehospital medical response team in the conflict setting. J R Army Med Corps. 2007; 153:(4)269-73

Fenton P, Bali N, Sargeant P A complication of the use of an intra-osseous needle. J R Army Med Corps. 2009; 155:(2)110-1

Gunning M, O’Loughlin E, Fletcher M Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service. Emerg Med J. 2009; 26:(1)65-9

Hassid VJ, Schinco MA, Tepas JJ Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury. J Trauma. 2008; 65:1328-32

Helm M, Hossfeld B, Schafer S Factors influencing emergency intubation in the prehospital setting—a multicentre study in the German Helicopter Emergency Medical Service. Br J Anaesth. 2006; 96:(1)67-71

Hodgetts TJ, Mahoney P, Evans G: Defense Medical Education and Training Agency; 2006a

Hodgetts TJ, Mahoney PF, Russell M ABC: redefining the military trauma paradigm. Emerg Med J. 2006b; 23:(10)745-6

Hodgetts TJ, Mahoney PF Military prehospital care: why is it different?. J R Army Med Corps. 2009; 155:(1)4-8

Jacobson LE, Gomez GA, Sobieray RJ Surgical cricothyroidotomy in trauma patients: analysis of its use by paramedics in the field. J Trauma. 1996; 41:15-20

Kelly JF, Ritenour AE, Mclaughlin DF Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus.64: S21-6; discussion S26–7; 2008

Kortbeek JB, Al Turki SA, Ali J Advanced trauma life support, 8th edition, the evidence for change. J Trauma. 2008; 64:(6)1638-50

Kozen BG, Kircher SJ, Henao J An alternative hemostatic dressing: comparison of CELOX, HemCon, and QuikClot. Acad Emerg Med. 2008; 15:(1)74-81

Lee C, Porter KM, Hodgetts TJ Tourniquet use in the civilian prehospital setting. Emerg Med J. 2007; 24:(8)584-7

Mahoney PF, Steinbruner D, Mazur R Cervical spine protection in a combat zone. Injury. 2007; 38:1220-2

Section 3. Treatment Guidelines. Clinical Guidelines for Operations. 4-03.1: 17–21; 2008

Owens BD, Kragh JF, Macaitis J Characterization of extremity wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2007; 21:(4)254-7

Owens BD, Kragh JF, Wenke JC Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008; 64:(2)295-9

Parker PJ Casualty evacuation timelines: an evidence-based review. J R Army Med Corps. 2007; 153:(4)274-7

Ramasamy A, Midwinter M, Mahoney P Learning the lessons from conflict: prehospital cervical spine stabilisation following ballistic neck trauma. Injury. 2009; 40:(12)1342-5

Suyama J, Knutsen C, Northington WE IO versus IV access while wearing personal protective equipment in a HazMat scenario. Prehosp Emerg Care. 2007; 11:(4)467-72

Tai NR, Brooks A, Midwinter M Optimal clinical timelines—a consensus from the academic department of military surgery and trauma. J R Army Med Corps. 2009; 155:(4)253-6

Walters TJ, Wenke JC, Kauvar DS Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care. 2005; 9:(4)416-22

Wang HE, Sweeney TA, O’Connor RE Failed prehospital intubations: an analysis of emergency department courses and outcomes. Prehosp Emerg Care. 2001; 5:134-41

Wardrope J, Ravichandran G, Locker T Risk assessment for spinal injury after trauma. BMJ. 2004; 328:(7442)721-3

Aspects of military prehospital care

04 February 2011
Volume 3 · Issue 2

Abstract

The military prehospital care experience has adapted civilian practice to reflect the nature of injuries sustained in recent conflicts. The main adaptations stem from differences in the mechanism of injury, clinical timelines and personnel. The large number of blast injuries and resulting extremity trauma means that an emphasis is placed on the control of catastrophic haemorrhage using a number of novel haemostatic strategies. This paradigm of <C>ABC is now universally followed and differs from civilian practice in a number of other ways— particularly in the management of C-spine, airway, chest injuries and circulatory access. This review highlights these differences in practice and outlines military techniques and protocols. It also emphasizes those areas in which civilian practice has borrowed from its military counterparts and successfully employed their techniques. This may become more relevant in the modern, post-September 11th era, in which urban mass casualty incidents are no longer a fictional fear.

Both military and civilian prehospital care provision are constantly evolving. Whereas the nature of conflict has changed in recent years, that change has also been reflected in the challenges faced by civilian prehospital care practitioners. Most notably since September 11th, 2001 (Cushman et al. 2003) and also following other large, urban mass casualty incidents (Bland et al, 2006; Carresi, 2008), civilian practitioners can also be faced with injuries similar to those seen in modern combat environments.

In recent years, military deployments in Iraq and Afghanistan have seen service medical personnel gain considerable experience in the prehospital management of severely injured casualties (Owens et al, 2008). This has necessitated the rapid evolution of both management algorithms and the equipment carried and used by prehospital teams (Hodgetts et al, 2006b).

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