Treatment Of Casualties Research Articles

To study the incidence of missed Distal Radio-Ulnar Joint (DRUJ) injuries, its’ early diagnosis by dynamic C.T. Scan and Management by modified Kapanji method

Background and Method: All the patients coming to the Department of Orthopaedics of Index Medical College Hospital & Research Centre, Indore, with an aim to Study The Incidence of missed Distal Radio-Ulnar Joint (Druj) Injuries, Its’ Early Diagnosis by Dynamic C.T. Scan and Management by Modified Kapanji Method and diagnosed with distal radio-ulnar joint injuries. All the trauma cases were received in the casualty and primary treatment with detailed examination and required imaging studies were done. The x-ray included antero-posterior and posterio-anterior views with dynamic CT scan and CT scan for head injury patient was donr through all investigation operative procedure were planned. The required consent was taken by the patient beforehand. Result: DRUJ injuries are more prevalent among young males than females. In age group 16 to 30 female (45%) is higher than male (38.8%). DRUJ injuries was seen more in left (55%) than right (45%) hand. Fall on out stretched hand (58%) is the major mechanism of DRUJ injuries followed by trivial trauma in 42%. DRUJ injury was missed in 18.33%, chronic in 20%, acute in 38.33% and sub-acute in 23.33%. Conclusion: Present study conclude that DRUJ injuries are more prevalent among young males than females. DRUJ injuries was seen more in left (55%) than right(45%) hand with fall on out stretched hand is the major mechanism. Physical examination is effective in diagnosis; radiological examination suggested for further investigations. Positive symptoms of DRUJ injuries were in 100%, physical examination was positive in 85% and negative in 15%. Positive CT findings in 66.67% and negative in 33.33%. X-ray findings were positive in 71.67% and negative in 28.33%.

Combat-related ocular injuries in the Israel Defense Forces during the years 2013 to 2019.

Ocular injuries account for up to 13% of battle injuries, despite the implementation of advanced protective eyewear (PE). The aim of this study was to describe the extent of ocular injuries over the last years among Israel Defense Forces soldiers and to examine the change in PE policy introduced in 2013 and the effect of a high-intensity conflict on ocular injury characteristics. This retrospective registry-based analysis derived data from the Israel Defense Forces Trauma Registry and included soldiers who sustained combat-related ocular injuries between the years 2013 and 2019. Demographic data and injury characteristics of casualties, as well as information regarding the use of PE, were collected and analyzed. A total of 2,312 military casualties were available for this study; the incidence of combat-related ocular injuries was 8.9% (n = 113). Ocular injuries occurred among male soldiers (98.2%) with a mean ± SD age of 22.7 ± 4.6 years; mechanism of injury was penetrating in 59.3% of the casualties and blunt in 22.1% of the casualties, ocular injury was isolated in 51.3% of the casualties, and others sustained concomitant injuries including head (32.7%), upper extremity injury (17.7%), lower extremity (15.9%), torso (8.0%), neck (6.2%), and other (5.9%) injuries. Ocular injuries rate was similar among casualties who used PE (11.2%) and those who did not use PE (13.0%) while injured (p = 0.596). Rate of open globe injuries was 9.1% in casualties who used PE and 39.5% (p = 0.002) in casualties who did not. Eye protection may significantly reduce ocular injuries severity. Education of the combatants on the use of PE and guidance of medical teams on proper assessment, initial treatment, and rapid evacuation of casualties are needed to improve visual outcomes of the casualties further. Epidemiological study, level IV.

Columbia Icefield Bus Rollover: A Case Study of Wilderness Mass Casualty Triage, Treatment, and Transport

Mass casualty incidents (MCIs) are rare in wilderness and mountain settings. Few case studies have reported the response of such events within jurisdictions with well-developed trauma and emergency medical services systems (EMS). Here we explore a MCI in a wilderness setting on the Columbia Icefield inside the Jasper National Park within the Canadian Rocky Mountains. An all-terrain bus was involved that had rolled over while transporting tourists to explore the glacier. The bus rolled multiple times down the slope adjacent to the road, leading to 3 deceased and 21 patients requiring transport. A massive pre-hospital response ensued. Due to the location, extreme environment, and unusual complexities, the response involved significant use of aeromedical resources, physician field deployment, and centralized coordination centers. Readers are reminded of the importance of aeromedical surge capacity in allowing for effective distribution of patients to multiple receiving facilities. Our experience aligns with and reinforces many of the recommendations for wilderness MCI management; however, future research should focus on determining optimal triage strategies for mountain MCIs. Furthermore, future research should explore optimal strategies for developing a rescue chain given the availability of mixed transport resources, as well as the role of physicians in MCI response and where they are best placed in the incident command system.

Acute Mild Traumatic Brain Injury Assessment and Management in the Austere Setting-A Review.

Traumatic brain injury (TBI) continues to be a major source of military-related morbidity and mortality. The insidious short- and long-term sequelae of mild TBIs (mTBIs) have come to light, with ongoing research influencing advances in patient care from point of injury onward. Although the DoDI 6490.11 outlines mTBI care in the deployed setting, there is currently no standardized training requirement on mTBI care in the far-forward deployed setting. As the Joint Trauma System (JTS) is considered to be one of the leaders in standard of care trauma medicine in the deployed environment and is often the go-to resource for forward-deployed medical providers, it is our goal that this review be utilized by the JTS with prominent mTBI resources to disseminate a clinical practice guideline (CPG) appropriate for the far-forward operational environment. The resources used for this review reflect the most current data, knowledge, and recommendations associated with research and findings from reputable sources as the Traumatic Brain Injury Center of Excellence (TBI CoE; formerly the Defense and Veterans Brain Injury Center), the Center for Disease Control and Prevention, as well as prominent journals such as Academic Emergency Medicine, British Journal of Sports Medicine, and JAMA. We searched for articles under keyword searches, limiting results to less than 5 years old, and had military relevance. About 1,740 articles were found using keywords; filters on our search yielded 707 articles, 100 of which offered free full text. The topic of far-forward deployed management of mTBI does not have a robust academic background at this time, and recommendations are derived from a combination of academic evidence in more traditional clinical settings, as well as author's direct experience in managing mTBI casualties in the austere environment. At the time of this writing, there is no JTS CPG for management of mTBI and there is no pre-deployment training requirement for medical providers for treating mTBI casualties in the far-forward deployed setting. The TBI CoE does, however, have a multitude of resources available to medical providers to assist with post-mTBI care. In this article, we review these clinical tools, pre-planning considerations including discussions and logistical planning with medical command, appropriate evaluation and treatment for mTBI casualties based on TBI CoE recommendations, the need for uniform and consistent documentation and diagnosis in the acute period, tactical and operational considerations, and other considerations as a medical provider in an austere setting with limited resources for treating casualties with mTBIs. Given the significant morbidity and mortality associated with mTBIs, as well as operational and tactical considerations in the austere deployed setting, improved acute and subacute care, as well as standardization of care for these casualties within their area of operations is necessary. The far-forward deployed medical provider should be trained in management of mTBI, incorporate mTBI-associated injuries into medical planning with their command, and discuss the importance of mTBI management with servicemembers and their units. Proper planning, training, standardization of mTBI management in the deployed setting, and inter-unit cooperation and coordination for mTBI care will help maintain servicemember readiness and unit capability on the battlefield. Standardization in care and documentation in this austere military environment may also assist future research into mTBI management. As there is currently no JTS CPG covering this type of care, the authors recommend sharing the TBI CoE management guideline with medical providers who will be reasonably expected to evaluate and manage mTBI in the austere deployed setting.

A sebkezelés fejlődésének története

The beginning of wound care dates back many thousand years. To make the wet wound treatment as it is used today so effectively had a bumpy road so far. Recognition of local processes, mapping of the effectiveness of materials needed for wound care, bleeding attenuation and traumatic shock management, destruction of invading pathogens, ensuring optimal hygiene for wound care, treatment of the underlying disease in chronic wounds, all contribute to our contemporary effective care. The series of military campaigns over millennia substantially promoted the treatment of casualties, and many achievements spreading in our day-to-day practice were taken over from the field surgery.

Disaster Relief Management Using Reinforcement Learning-Based Routing

Effective disaster management is required for the peoples who are trapped in the disaster scenario but unfortunately when disaster situation occurs the infrastructure support is no longer available to the rescue team. Ad hoc networks which are infrastructure-less networks can easily deploy in such situation. In disaster area mobility model, disaster area is divided into different zones such as incident zone, casualty treatment zones, transport areas, hospital zones, etc. Also, in order to tackle high mobility of nodes and frequent failure of links in a network, there is a need of adaptive routing protocol. Reinforcement learning is used to design such adaptive routing protocol which shows good improvement in packet delivery ratio, delay and average energy consumed.

Back to the Future: Whole Blood Resuscitation of the Severely Injured Trauma Patient.

ABSTRACTFollowing advances in blood typing and storage, whole blood transfusion became available for the treatment of casualties during World War I. While substantially utilized during World War II and the Korean War, whole blood transfusion declined during the Vietnam War as civilian centers transitioned to blood component therapies. Little evidence supported this shift, and recent conflicts in Iraq and Afghanistan have renewed interest in military and civilian applications of whole blood transfusion. Within the past two decades, civilian trauma centers have begun to study transfusion protocols based upon cold-stored, low anti-A/B titer type O whole blood for the treatment of severely injured civilian trauma patients. Early data suggests equivalent or improved resuscitation and hemostatic markers with whole blood transfusion when compared to balanced blood component therapy. Additional studies are taking place to define the optimal way to utilize low-titer type O whole blood in both prehospital and trauma center resuscitation of bleeding patients.

Assessment of community vulnerability and medical surge capacity in a foreseeable major disaster.

ObjectiveDeveloping an adequate disaster response capacity involves an assessment of available resources in areas that are vulnerable to disaster. Here, we sought to evaluate the gap between predicted damage in a foreseeable major earthquake versus existing municipality-level resources in Tokyo, Japan.MethodsOur study focused on the 53 municipalities in Tokyo to evaluate the relationships between the predicted number of severe casualties per 1,000 population from a future earthquake, community characteristics, and inpatient bed supply in local hospitals. Correlation analysis and supply–demand balance estimations were carried out at the municipality level, and the results were geographically visualized using choropleth maps.ResultsThe correlation analysis showed that higher casualties were correlated with municipalities with faster population increase, higher taxable incomes, lower unemployment rates, and higher bed volumes in disaster base hospitals. Under a maximal damage scenario in a future earthquake, we predict a shortage of 2,780 beds for the treatment of severe casualties across Tokyo. Even under a scenario of cooperation among neighboring municipalities, a shortage of 7,107 beds would remain.ConclusionsTokyo is located in a zone where major earthquake damage is anticipated. Cooperation between neighboring municipalities may not suffice to address the undersupply of beds during the acute phase of a disaster. Hence, existing disaster preparedness plans require further reinforcement with a focus on local vulnerabilities.

Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients

BackgroundPost-traumatic acute kidney injury has occurred in every major military conflict since its initial description during World War II. To ensure the proper treatment of combat casualties, early detection is critical. This study therefore aimed to investigate combat-related post-traumatic acute kidney injury in recent military conflicts, used machine learning algorithms to identify clinical and biomarker variables associated with the development of post-traumatic acute kidney injury, and evaluated the effects of post-traumatic acute kidney injury on wound healing and nosocomial infection. MethodsWe conducted a retrospective clinical cohort review of 73 critically injured US military service members who sustained major combat-related extremity wounds and had collected injury characteristics, assayed serum and tissue biopsy samples for the expression of protein and messenger ribonucleic acid biomarkers. Bivariate analyses and random forest recursive feature elimination classification algorithms were used to identify associated injury characteristics and biomarker variables. ResultsThe incidence of post-traumatic acute kidney injury was 20.5%. Of that, 86% recovered baseline renal function and only 2 (15%) of the acute kidney injury group required renal replacement therapy. Random forest recursive feature elimination algorithms were able to estimate post-traumatic acute kidney injury with the area under the curve of 0.93, sensitivity of 0.91, and specificity of 0.91. Post-traumatic acute kidney injury was associated with injury severity score, serum epidermal growth factor, and tissue activin A type receptor 1, matrix metallopeptidase 10, and X-C motif chemokine ligand 1 expression. Patients with post-traumatic acute kidney injury exhibited poor wound healing and increased incidence of nosocomial infections. ConclusionThe occurrence of acute kidney injury in combat casualties may be estimated using injury characteristics and serum and tissue biomarkers. External validations of these models are necessary to generalize for all trauma patients.

Medical equipment trends during the UK military exercise SAIF SAREEA 3 in Oman

IntroductionEx SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical...

Visualization of the consequences of Succinate Dehydrogenase Inhibition on Oxygen utilization During Hemorrhagic Shock using Hyperspectral Imaging

IntroductionHemorrhagic shock (HS) results in reduced pressure, limited blood flow, and inadequate oxygen delivery to maintain cellular function. Reduced microcirculatory blood flow results in ischemia, as the tissue is no longer properly perfused or oxygenated. During resuscitation from HS, reperfusion promotes the formation of reactive oxygen species (ROS) as a byproduct of the Krebs cycle. Itaconate limits formation of ROS generated during reperfusion by inhibiting succinate dehydrogenase (SDH) activity, thus limiting tissue and organ damage. Hyperspectral Imaging (HSI) can be used to interrogate hemoglobin oxygen (HbO2) saturation in microvessels. Thus, the objective of this study was to use HSI to monitor changes in oxygen utilization within the microcirculation during resuscitation from HS with itaconate pretreatment.Materials and MethodsGolden Syrian hamsters were instrumented with a dorsal window chamber. A Resonon Pika‐L (Resonon, Bozeman, MT, USA) bench top HSI system was used. Each image was fitted with a Spatial mean filter and Savitzky‐Golay filter to decrease scatter noise, and a vessel mask was applied based on an intensity threshold to remove tissue from blood vessels. Spectral rescaling and a linear least squares fit were used to provide abundance of Hb and HbO2. Hemorrhage was induced by withdrawing 50% of the animal’s blood volume (BV, estimated as 7% of body weight) over 10 minutes. During hemorrhage and shock, images were taken continuously using a custom Python algorithm controlling the camera and illumination with a custom build relay. Before fluid resuscitation, itaconate was administered. Fluid resuscitation was accomplished by infusion of 25% of the animal’s BV of HEXTEND® (6% Hetastarch in Lactated Electrolyte Injection. Hospira Inc, Lake Forest, IL). The animal was resuscitated over 10 minutes and images taken every minute. Recovery was monitored over a period of 1 hour with images taken every 5 minutes.Results and DiscussionIncreasing doses of itaconate restored HbO2 saturation in venules, which confirms the inhibition of SDH by itaconate. Itaconate limits oxygen consumption of the tissues, preventing the formation of ROS in tissue during reperfusion, as indicated by higher levels of venular O2 saturation. However, these effects are only temporary as the HbO2 saturation levels taper off over time.ConclusionsIn conclusion, the inhibition of SDH with itaconate lead to the accumulation of succinate, limited tissue oxygen utilization, and prevented the formation of ROS during reperfusion. With further research, itaconate could potentially help to reduce reperfusion sequalae post treatment of trauma injuries, surgery, and combat casualties. In future studies, we aim to administer itaconate as an additive to the resuscitation fluid with the goal of evaluating the long‐term implications of preventing reperfusion injury.Support or Funding InformationThis study was supported by NIH NHLBI R01HL126945 and R01HL138116.

Management of war-related vascular injuries: A civilian surgeon experience in the treatment of war casualties at a secondary care hospital

Background: This study presents the management of patients with war-related injuries and early results of vascular injuries treated at a secondary care hospital neighboring to civil war. Methods: Between December 2013-December 2014 ninety-six war-related injury patients evaluated by a single vascular surgeon and participating disciplines according to components of injury in polytrauma patients. Thirty-six patients who underwent vascular surgery were retrospectively registered to the study. Demographics, treatment and early results of patients reviewed. Results: Mean age was 26.69±11.80 (7-66) years and 91.66% (33/36) were males. Injuries were caused by shrapnel wound due to bombing 61.11% (22/36), stab wound 8.33% (3/36), gunshot wound 30.55 % (11/36). The number of patients with polytrauma was 29, seven patients had isolated vascular injury. Among 42 arterial and 31 venous injuries primary suture repair, autologous vein graft interposition and prosthetic graft interposition performed to 20.54% (15), 28.76% (21), 19.17% (14) respectively. Amputation and all-cause mortality were %8.3 (3/36), 13.8% (5/36) respectively. Conclusions: Vascular injury with concomitant trauma is the main issue of war-related injuries. Surgeons should be cautious about patients who were initially deemed not to need surgery for vascular injury and then were found to need it. Repetitive physical examination is very important in case of any suspicion, especially in limited conditions for diagnostic tools like CT angiography. A rapid, careful multidisciplinary evaluation of experienced surgeons for the diagnosis and the treatment priorities in war-related injury patients may lead to increase life and limb salvage rates with a better quality of life. Keywords: vascular system injuries, war-related injuries, mortality, amputation, multiple trauma.

Responding to nerve agent poisoning: a guide for emergency nurses. Part 2.

The release of chemical agents can cause loss of life and result in major incidents. Chemical agent-related major incidents require a modified response by emergency services due to the chemicals' transmissibility, lethality, latency and persistence. In general, modifications to casualty flow, triage and treatment are made to reduce transmissibility, and lethality of chemical hazards. This article, the second of a two-part series on nerve agents, describes the adapted response and explains how emergency nurses must be familiar with principles of care including incident and casualty management.

Study on the Facility Planning for Relief Logistics Relieving Damage from Natural Disaster

Recently, the magnitude and frequency of the natural disaster have been increased, the damage has become severer. The importance of disaster response system to relieve the damage has arised continuously. This study has tried to develop the algorithm to solve the facility location and size problem in emergency logistics. A facility in the emergency logistics has various roles in victim care, casualty treatment, relief resource management and relief vehicle assistance. Moreover, the location of facility in emergency logistics has to consider the safety and reliability. To gather these information, information management system with IoT sensors are suggested. The location problem in this study also covers various features to response various demands in disaster. To solve this problem, this study suggested MIP based algorithm. Scenario based simulation experiments are conducted to verify the performance suggested algorithm.

Dutch combat operation experiences in Iraq and Afghanistan: The conundrum of low surgical workload deployments

IntroductionThe Combined Joined Task Force - Operation Inherent Resolve is the military intervention of Iraq and Coalition Forces in the battle against Islamic State of Iraq and Syria (ISIS). Al Assad Airbase (AAAB) is one of the key airbases. It contains a Role 2 Medical Treatment Facility, primarily to perform Damage Control Surgery in Coalition Forces, Iraqi National Security Forces and Local Nationals. We present a six month medical exposure in order to provide insight into the treatment of casualties and to optimize medical planning of combat operations and (pre-/post-) deployment training. Patients and methodsThis is a cohort study of casualties that were admitted to the Role 2 Medical Treatment Facility AAAB from November 2017 to April 2018. Their mechanisms and types of injury are described and compared to those sustained in Uruzgan, Afghanistan between 2006–2010. Additionally, they are compared to the caseload in the Dutch civilian medical centers of the medical specialist team at AAAB. ResultsThere were significant differences in both mechanism and type of injury between Coalition Forces and Iraqi Security Forces (p = 0.0001). Coalition Forces had 100% disease and non-battle injuries, where Iraqi Security Forces had 86% battle injuries and 14% non-battle casualties. The most common surgical procedures performed were debridement of wounds (38%), (exploratory) laparotomy (10%) and genital procedures (7%). The surgical caseload in Uruzgan, Afghanistan was significantly different in aspect and quantity, being 4.1 times higher. When compared to the workload at home all team members had at least a tenfold lower workload than in their civilian hospitals. DiscussionThe deployed surgical teams were scarcely exposed to casualties at AAAB, Iraq. These low workload deployments could cause a decline in surgical skills. Military medical planning should be tailormade and should include adjusting length of stay, (pre-/post-)deployment refresher training and early consultation of military medical specialists. Future research should focus on optimizing this process by investigating fellowships in combat matching trauma centers, regional and international collaboration and refresher training possibilities to maintain the expertise of the acute military care provider.

Transfusion of cryopreserved platelets exacerbates inflammatory liver and lung injury in a mice model of hemorrhage.

Platelets are essential for primary hemostasis and also play an important role in inflammatory reactions. The hemostatic property of cryopreserved platelets (CPPs) has been confirmed in the treatment of bleeding casualties, but inflammatory injury induced by CPP transfusion is relatively unclear. We aim to investigate the effects of CPP transfusion on inflammatory organ injury in mice after hemorrhage. Mice were subjected to a volume-controlled hemorrhage over 1 hour, and then were transfused with fresh platelets (FPs), Liquid-stored platelets (LPPs), CPPs, or fresh frozen plasma (FFP, control). At 6 hours posttransfusion, mice were sacrificed, and blood and tissues were sampled. Tissue sections were examined histologically and by immunohistochemical staining of neutrophils and macrophages. Plasma alanine aminotransferase, hepatic myeloperoxidase activity and inflammatory cytokine levels were measured. Transfusion of stored platelets (LPPs and CPPs) caused more serious histological injury in liver and lung compared with FPs and FFP (p < 0.05). However, kidney histological injury was similar among groups. Significantly higher numbers of Ly-6G-positive neutrophils were detected in liver and of F4/80-positive macrophages in liver and lung of mice transfused with LPPs or CPPs compared with FPs or FFP (p < 0.05). Transfusion of CPPs caused the most severe inflammatory liver injury, as reflected by alanine aminotransferase levels, hepatic macrophage infiltration, and hepatic myeloperoxidase activity and inflammatory cytokine levels (macrophage inflammatory protein-2, tumor necrosis factor-α, and interleukin-1β). Cryopreserved platelet transfusion is more likely to aggravate hemorrhage-induced liver and lung injury by activating macrophage and facilitating neutrophil infiltration into hepatic tissues.

Challenges for rescue and treatment of mass burns: the experience of rescue and treatment for casualties in August 2nd Kunshan factory aluminum dust explosion accident

The Kunshan factory aluminum dust explosion accident in August 2nd, 2014 caused the largest number of serious burn casualties in China in the recent 30 years. With the support of the whole country and the multidisciplinary cooperation, 185 severely burned patients were rescued and treated at 20 hospitals in Jiangsu province and Shanghai with satisfactory results. The rescue and treatment of mass burn is a complicated and systematic project on account of its suddenness, uncertainty, and non-repeatability. The treatment of this explosion accident was reviewed in this paper to explore the treatment model and experience of multidisciplinary cooperation. It is worthy to ponder and explore how to face challenges and strive to improve the treatment level of mass burns.

BIOMETRIC ASPECTS IN TREATMENT OF COMBINED TRAUMA

The objective is to determine the optimal tactics in treatment of combined trauma using the objective assessment of the severity of injuries and the overall condition of the casualties. Material and methods . The article presents the materials on biometric analysis of treatment of casualties with combined trauma in the program of multi-staged surgical treatment. Results. In the process of multi-staged surgical treatment, we can determine the prognosis, the nature of the traumatic disease with the help of a biometric comprehensive study that will optimize comprehensive treatment program and rehabilitation of casualties in the trauma center of the 1st level. Conclusion. The conditions for the application of the full spectrum of surgical interventions in the maxillofacial region in the acute period of traumatic disease are created in favorable prognosis. The choice of treatment in favorable or unfavorable prognosis is a multistaged surgical tactics of treatment – Damage control surgery.

Blood transfusion management in the severely bleeding military patient.

Hemorrhage remains the primary cause of preventable death on the battlefield and in civilian trauma. Hemorrhage control is multifactorial and starts with point-of-injury care. Surgical hemorrhage control and time from injury to surgery is paramount; however, interventions in the prehospital environment and perioperative period affect outcomes. The purpose of this review is to understand concepts and strategies for successful management of the bleeding military patient. Understanding the life-threatening nature of coagulopathy of trauma and implementing strategies aimed at full spectrum hemorrhage management from point of injury to postoperative care will result in improved outcomes in patients with life-threatening bleeding. Timely and appropriate therapies impact survival. Blood product resuscitation for life-threatening hemorrhage should either be with whole blood or a component therapy strategy that recapitulates the functionality of whole blood. The US military has transfused over 10 000 units of whole blood since the beginning of the wars in Iraq and Afghanistan. The well recognized therapeutic benefits of whole blood have pushed this therapy far forward into prehospital care in both US and international military forces. Multiple hemostatic adjuncts are available that are likely beneficial to the bleeding military patient; and other products and techniques are under active investigation. Lessons learned in the treatment of combat casualties will likely continue to have positive impact and influence and the management of hemorrhage in the civilian trauma setting.

Expert consensus on the evaluation and diagnosis of combat injuries of the Chinese People\u2019s Liberation Army

The accurate assessment and diagnosis of combat injuries are the basis for triage and treatment of combat casualties. A consensus on the assessment and diagnosis of combat injuries was made and discussed at the second annual meeting of the Professional Committee on Disaster Medicine of the Chinese People's Liberation Army (PLA). In this consensus agreement, the massive hemorrhage, airway, respiration, circulation and hypothermia (MARCH) algorithm, which is a simple triage and rapid treatment and field triage score, was recommended to assess combat casualties during the first-aid stage, whereas the abbreviated scoring method for combat casualty and the MARCH algorithm were recommended to assess combat casualties in level II facilities. In level III facilities, combined measures, including a history inquiry, thorough physical examination, laboratory examination, X-ray, and ultrasound examination, were recommended for the diagnosis of combat casualties. In addition, corresponding methods were recommended for the recognition of casualties needing massive transfusions, assessment of firearm wounds, evaluation of mangled extremities, and assessment of injury severity in this consensus.