Military Resuscitation: Lessons from Recent Battlefield Experience

Abstract

Purpose of Review

This review will discuss the current methods employed in military trauma systems to care for combat casualties, with emphasis on what is referred to in NATO doctrine as “Role 1” and “Role 2” medical support—that is, care of the war-injured patient at the point of injury and, slightly further “upstream” in the trauma system in a forward, mobile trauma system.

Recent Findings

Tactical Combat Casualty Care is continuously updated by the Joint Trauma System in a rigorous manner. New technologies and procedures are constantly being investigated and adapted to the tactical demands of the battlefield. The most significant recent developments are the introduction of tranexamic acid, the advent of 1:1:1 blood product therapy, widespread use of tourniquets, and lyophilized or “freeze-dried” plasma to overcome the barriers inherent in frozen plasma.

Summary

Current doctrine in military medicine is the ultimate expression of damage control resuscitation. Realities of the modern battlefield often necessitate novel approaches to care that emphasize mobility over robustness and temporizing measures over definitive. While these methods would perhaps seem suboptimal to the civilian trauma surgeon, the preventable mortality in the recent conflicts in Iraq and Afghanistan was lower than for any other modern war [1], and fell after the lessons of the early phases of the wars lead to development of the prehospital guidelines developed by the Committee on Tactical Combat Casualty Care (TCCC), now overseen by the Joint Trauma System (JTS) [2, 3]. The JTS oversees the delivery of trauma care to war-wounded personnel from point of injury to convalescence in the continental USA. It regularly updates its clinical practice guidelines [3]. Controlling hemorrhage, the primary cause of preventable battlefield deaths (>80%) [4, 5] is the primary goal in TCCC and the JTS. Far from being applicable only to combat trauma, the lessons learned in the recent wars have tangible benefits in disaster response and mass civilian trauma, particularly in this age of seemingly random mass shootings in the US and assorted terror attacks in Europe and throughout the world. This review will describe the system in which the US Armed Forces delivers care to patients injured on the modern battlefield, the tenants that guide that care, and the scientific basis for the most current developments in the field.