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KEY POINTS

KEY POINTS

  • The Joint Trauma System (JTS) has been identified by Congress in the National Defense Authorization Act for Fiscal Year 2017 as the reference body for trauma care in the Department of Defense.

  • Died of wounds is the term used for mortality of casualties who arrive at a medical treatment facility alive and succumb to their injuries.

  • The case fatality rate historically has trended with percent killed in action.

  • The transition from gunshot wounds to blast injuries such as from the improvised explosive devices used in Iraq and Afghanistan has been in evolution since the US Civil War.

  • Almost 90% of combat casualties who succumb to their wounds do so before they arrive at a medical treatment facility.

  • Combat units that have trained all of their unit members, not just medics, in tactical combat casualty care have achieved the lowest incidence of preventable death on the battlefield in the history of modern warfare.

  • In military roles of care, role 2 is the first level of care that has surgical capability, such as the forward surgical teams used by the US Army in the recent conflicts.

  • A Critical Care Air Transport Team refers to the augmented aeromedical evacuation-type platform with specific capabilities for intensive care unit care.

  • For transfusion of whole blood to military casualties, only group O whole blood donors with low titers of anti-A and anti-B antibodies are used.

  • Kaolin-based dressings like Combat Gauze work by accelerating clotting pathways.

INTRODUCTION

He who wishes to be a surgeon must first go to war.

  Hippocrates (460–377 BC)

 

How varied was our experience of the battlefield and how fertile the blood of warriors in rearing good surgeons.

  Thomas Clifford Allbutt (1836–1925)

 

The military surgeon is faced with the challenge of preservation of life in an environment of destruction where loss of life is far too commonplace. Historically war comes at the cost of human life; battlefield medics deploy to this environment to alleviate pain and suffering, care for the wounded, preserve the fighting strength, and save lives. Medicine and surgery have seen great advances during times of large casualty volumes; the Mayo brothers are credited with the quote: “The only victor in war is medicine.” The current conflicts in the Middle East have spanned over two decades and represent the longest conflicts in US history. During this period, there have been significant advances in prehospital care, hemostasis, resuscitation, evacuation, damage control surgery, and transfusion strategies. Vice Admiral Alasdair Walker, Surgeon General of the British Armed Forces, described a concept now referred to as the “Walker Dip” during the 2013 Military Health System Research Symposium. The Walker Dip describes the recurrent historical cycle where medical care improves during conflicts, the lessons are forgotten after, and then are relearned again during the next war. Unfortunately, the Walker ...

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