Discussions of the past help to move military medicine to the future
Management of critical care patients in combat remained the focus of discussions at the Advanced Technology for Applications and Combat Casualty Care conference of 2010 in St. Petersburg, Fla.
Experts from around the world continue to discuss the latest technologies, advancements and experiences which have the potential to provide injured Soldiers with improved quality treatment. Topics such as managing burn victims, pelvic fractures, pain control and necessary pre-hospital treatment were among the topics discussed.
Civilian medical equipment during transport and hospitalization, including monitors, oxygen or even blood pressure cuffs are necessities that are often readily available and help save lives. This same equipment when entered into harsh environments today's Soldier is exposed to, often does not operate correctly. It may not fit in the helicopter or may not even be available. Standard operating procedures continue to evolve in areas such as pre-hospitalization intervention and determining standard of care.
War brings new experiences and healthcare professionals in the military are trying to determine what is needed to increase survival and develop training programs for first responders to ensure that guidelines are met and lives are saved.
In the U.S., burns are typically the result of residential fires, crashes, electricity, chemicals or hot liquids. During war, burns are typically the result of explosions and much is still being learned. Victims are very difficult to treat and often are in tremendous pain, requiring around the clock monitoring for infection and pain management. For the soldier in the field, not all the comforts of home may be available immediately. During combat, the management of burns prior to arrival at a hospital is critical. Some estimate that time from injury to hospital to be around 43 minutes.
Maj. Kim Lairet of the U.S. Army Institute of Surgical Research presented a study regarding pre-hospital burn management in the combat zone. The study found the standard of care varies depending on resources and training. Keeping burn patients warm during transport remains critical however, resources may not be available and it is not always occurring. The level of fluids given to patients is often challenging and can lead to injuries. Too little fluid can lead to possible kidney injuries. One the other hand too much can lead to compartment syndrome. She stressed that if what is being done in the field can be identified and determine what is effective, then training can be developed to assist first responders and allow the mission to be continued.
The things that are done during pre-hospitalization play a significant role in the outcome of traumatic brain injury. Capt. John Ritchie from Brooke Army Medical Center examined different studies to determine whether providers in combat theater are providing support in accordance with the Brain Trauma Foundation guidelines. Scientist found that oxygen and carbon dioxide levels, blood pressure and ventilation all play an important role.
The results of the study revealed that optimal blood pressure, oxygenation and carbon dioxide levels were evident at arrival for those involved in the study. While blood pressure and blood oxygenation were nearly optimal, between 20 and 80% of patients had abnormal, either high or low, levels of carbon dioxide in their blood and would benefit from mechanical ventilation as well as a means to measure carbon dioxide levels en route to care.
Presenters felt that correct steps were taken however, as Ritchie stated, "if a product could be developed that would combine all the technical requirements into one, meet all the standards and still be able to fit on a helicopter, it would be ideal."
Ideas and innovation is what the exhibit halls were all about. Promising new techniques and products that are easily transportable, could be calibrated to adjust to various external conditions and all developed to improve the quality of care given to Soldiers and save lives.
As medicine evolves, it remains imperative that training and procedures evolve as well. New discoveries or therapies are only as helpful as those that know they exist and how to administer.
It is through past experiences, gathering of data and recognizing needs that will permit trauma medicine to move forward.