The Symbiosis of Combat Casualty Care and Civilian Trauma Care: 1914–2007

Abstract

Abstract : Over the past 93 years, experience in the care of combat casualties and biomedical research activities by the U.S. military, focused on the problems occurring in combat casualties, have contributed significantly to overall surgical progress. Treatment refinements developed during wartime and research findings generated during conflict and the interbellum periods have been transferred to the civilian community to improve the care of all trauma patients. Similarly, technological developments and research findings generated in civilian laboratories have been readily integrated into military trauma care. Advances in wound care include effective topical antimicrobial chemotherapy for burns and other problem wounds, and the use of infection monitoring and surveillance systems to facilitate infection control in the ICU. Refinements of fluid resuscitation have essentially eliminated acute renal failure as a complication in combat casualties and have identified the hazards of excessive resuscitation (which are of considerable current interest). Civilian trauma patients have benefited by the transfer of prophylactic hemodialysis, the use of high pressure interrupted flow-positive pressure lung-protective ventilation, and the development of full-spectrum metabolic support regimens. The organization and delivery of civilian trauma care has been materially enhanced by adopting and adapting the military use of helicopters for patient transport and the establishment of trauma and burn centers within hierarchical regional trauma systems. This article reviews the advances in combat casualty care and civilian trauma care that have occurred from 1914 through 2007, and the symbiotic quality of the relationship between the two systems of care. The review encompasses World War I, World War II, the Korean War, the Vietnam War, advances in burn care, Operations Desert Shield/Desert Storm, and Operations Enduring Freedom and Iraqi Freedom.