Military trauma management

National Jewish Hospital is not a trauma hospital, in fact it doesn't even have beds for overnight stays except in pediatrics. But it has a diverse set of doctors and one I spoke with today fascinated me with military trauma information. His name is Dr. Richard Meehan and he is a rheumatologist who also spent time in Iraq as a critical care physician. He describe some very interesting details about the day-to-day of the soldiers in the field. These are some observations from that discussion.



Each individual soldier is now expected to care for himself during active combat. In a combat situation medics are usually not deployed to soldiers, as we all know from the movies. Nobody calls out "medic" when they are hit or hurt in combat because the military has learned that the next person to be targeted for kill will be the medic. Apparently a medic is a valuable target since killing the medic means no more care for all the other soldiers and a dead medic is terrible for the moral of the guys fighting.



So each soldier carries a medical pack including an airway to let a comrade, who is choking on his tongue, breathe, a tourniquet, a dressing that has clotting material impregnated in it for bleeding (apparently this hurts like hell since the clotting factor generates heat, but it's this or bleed to death), a large needle to allow decompression of a collapsed lung, antibiotics and pain medicine. The tourniquets are designed so the soldier can put it on with one hand.



Once fighting has stopped medics will be available and they carry more equipment including an eye trauma kit, an otoscope (if a soldier suffers head trauma from an IED an indication for evacuation is a ruptured ear drum), suture kits, and lots of tourniquets and impregnated dressings, medications including narcotics that they sign out immediately before hitting the field and sign in immediately upon returning, moldable splints and dressings for sucking chest wounds. This is called is called an Ashleman's Patch and works by creating an airtight seal on the chest while the patch has a one way valve to let air leave an open chest wd but doesn't allow air into the chest. This allows for the lung to re-expand.



Soldiers are taught triage as follows: if a fellow soldier is not breathing they are considered dead, there is no way for advanced life support to be administered in the field (although I expect there can be exceptions to this), if someone is having difficulty breathing-a soldier applies the airway in their personal kit, positions the soldier on his/her left side and moves on. A soldier is expected to STOP ALL BLEEDING with dressings and tourniquets. This is a huge source of morbidity and mortality in the field. As Dr. Meehan commented, "Of the A(airway)-B(breathing)-C(circulation)s of life support, the C becomes most important in the field.


A soldiers helmet is designed with gel shock absorbers that limit risk for intracranial bleeding.