Military Perspective in Trauma Care

Abstract

This chapter deals with important protocolized concepts of trauma care in an austere environment. The challenges faced by combatants are unique and include (a) the ongoing threat level to the wounded and the first responder, (b) probability of mass casualty events, (c) limited resources, (d) a lack of availability of expertise/basic diagnostic technology and local healthcare support, and (e) transfer capability of the injured. This was genesis of the concept of Tactical Combat Casualty Care (TCCC). This chapter emphasizes the concept of TCCC and describes its three phases: (1) Care Under Fire (CUF), (2) Tactical Field Care (TFC) and (3) Tactical Evacuation Care (TACEVAC). The continuum of critical care during the transport of the injured combatant is vital. TCCC in the face of inhospitable terrain and extreme temperatures is always a challenge. A delay in evacuation of casualties from the ongoing theatre of war adds to the complexity of the situation. Timely initiation of the MARCHE protocol is imperative. It consists of massive haemorrhage, airway management, respiration/breathing, circulation, hypothermia prevention and everything else (analgesia, antibiotics, monitoring, etc.). Advanced Trauma Life Support – Operational Emphasis (ATLS-OE) is an important concept which has been included in the ATLS (10th edition). The concept of zero survey and that of quaternary survey has been highlighted in ATLS-OE. The modifications in the ATLS algorithm to introduce the nuances of combat are not just about saving lives but to give quality care at the very onset to provide quality life thereafter.