Military Trauma System Response to Blast MCI

Abstract

Explosions were the most common source of injury during Operation Enduring Freedom and Operation Iraqi Freedom. A single blast can generate numerous casualties with complex injuries. When these patients overwhelm a medical system, a mass casualty incident occurs. The United States Military has been at the forefront of trauma management, and this includes the management of blast injuries and mass casualty incidents. Following the establishment of scene and medical facility security, the management of a mass casualty incident begins with appropriate triage. The ultimate goal of triage is to provide the greatest good for the greatest number of patients. The triage officer, ideally an experienced trauma surgeon, assigns patients to four possible triage categories: immediate, delayed, minimal, and expectant. While most civilian emergency departments are concerned with undertriage, overtriage can be especially dangerous during a mass casualty incident due to the resulting resource misallocation. During the triage process, patients should be entered into a patient identification system and medical record should be generated. Mass casualty incidents require a surge of resources to include blood products. Blast injury patients are more likely to require massive transfusions as compared to injuries from small arms. A potential source of blood products is fresh whole blood. For the military, the management of injuries is divided amongst defined four roles of care. Each role has a set amount of resources and skills that the next higher role builds upon. This ensures the orderly flow of injured patients from austere environments back to United States medical centers, such as the Walter Reed National Military Medical Center. Ultimately, effective mass casualty incident management depends on an established system that has undergone simulations and practice before the real event. In addition, each mass casualty incident should provide “lessons-learned” to ensure proper preparation for the next event.