Abstract
The conflicts in Iraq and Afghanistan have seen the advancement of combat medicine. The nature of the conflicts, with troops located in remote areas and faced with explosive ordinance designed to focus massive injuries on dismounted personnel, have forced military medical personnel to adapt accordingly. There has been a rekindling of interest in the use of tourniquets to stop exsanguination from extremity wounds, as well as in the transfusion of fresh whole blood from walking blood banks. These previously discarded techniques, born on battlefields long ago, have been refined and perfected and have led to an unprecedented survival for our wounded warriors. New developments in the field of applied hemostatic agents, damage control surgical techniques, and the implementation of an efficient evacuation system have also contributed to these results. The field of combat medicine has taken several concepts initially designed in civilian settings, such as temporary abdominal packing and vascular shunting, and adapted them to the military setting to provide state of the art trauma management to our troops in combat. In turn, developments in the resuscitation of the trauma patient, using increased blood and plasma products and less crystalloid, have been pioneered in conflict and transitioned to the civilian sector. Advancements made during the wars in Iraq and Afghanistan, as well as those still being developed, will shape the care of the injured patient, in both civilian and military settings, for the foreseeable future.
- massive transfusion
- military medicine
- tourniquets
- fresh whole blood
- damage control surgery
- damage control resuscitation
- aeromedical evacuation
- coagulopathy of trauma
Footnotes
- Correspondence: Jason J Schrager MD, Division of Trauma/Critical Care, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, PO Box 670558, Cincinnati OH 45267-0558. E-mail: jasonschrager13{at}hotmail.com.
The opinions expressed in this paper are not to be construed as official or as reflecting the policy of the U.S. Navy Reserve, the U.S. Air Force Reserve, or the Department of Defense. The authors report no conflicts of interest related to the content of this paper.
Dr Johannigman presented a version of this paper as the Donald F Egan Scientific Memorial Lecture at the AARC Congress 2011, held November 5–8, 2011, in Tampa, Florida.
- Copyright © 2012 by Daedalus Enterprises Inc.