Thoracic Trauma in Combat or Austere Environments

Abstract

Major traumatic injuries to the thorax can present significant challenges at even the most modern and well-equipped trauma centers. Additional significant challenges regarding the evaluation and management of these injuries arise in more resource-constrained environment such as the rural setting or on the battlefield during combat operations. The recent prolonged combat operations in Iraq and Afghanistan have resulted in a large body of experience and lessons learned related to combat thoracic trauma, and much of this can be applied to the civilian setting. Although advances in protective equipment and vehicles, as well as changes in the common mechanisms of wounding on the modern battlefield have impacted the incidence and severity of these injuries, they remain relatively common and carry a high morbidity and mortality. Initial evaluation and interventions should focus on identification and control of ongoing hemorrhage, rapidly determining the need for operative intervention, and then appropriate surgical decision-making including the need for an abbreviated initial damage-control procedure with more definitive repairs/reconstruction delayed until after the patient is stabilized and adequately resuscitated. Additional operational factors that must be considered and can alter management decisions include the tactical situation, the local supply and personnel situation, the need for evacuation to the next higher level of care, and the needs of other casualties in a mass casualty scenario. Keywords: Austere, blast injury, improvised explosive device, military, thoracic, torso, trauma.