Global lessons: developing military trauma care and lessons for civilian practice

Abstract

The wars in Iraq and Afghanistan have helped to shape the modern Defence Medical Services. Many lessons were learnt including the need for rapid haemorrhage control, senior decision-making and the evolution of deployed transfusion support. These changes were implemented simultaneously with a coherent, end-to-end medical plan from point of wounding through to rehabilitation. Implementation of the medical plan is harmonious with the NHS trauma pathway, and is key to ensuring effective delivery. Military anaesthetists have a long pre-deployment training pathway starting with a Certificate of Completion of Training (CCT) in anaesthesia and/or critical care, and with an emphasis on military skills related to their specific role. Pre-deployment training includes additional skill training, team training and finally whole hospital collective training. This pathway ensures ongoing and continuing competence on an individual basis, and assurance that hospital management systems and clinical staff can function effectively as a deploying unit.

Streamlining pre- and intra-hospital care for patients with severe trauma: a white paper from the European Critical Care Foundation

“…In recent years, a number of developments and measures have been implemented in various countries to improve early trauma care, such as injury prevention and educational programs (Advanced/Pre-Hospital Trauma Life Support or A/PHTLS, Definitive Surgical Trauma Care [DSTC] and Definitive Anaesthetic Trauma Care [DATC], team resource management, etc), rapid transport and designated trauma centres with specialised personnel, logistics and infrastructure to rapidly deliver appropriate diagnosis, care and rehabilitation [17][18][19]. Approaches, such as evacuation communication strategies (9-liner MEDEVAC request), derived from the military setting, are also currently being transferred into the civilian arena against the background of increasing threats through terror actions and attacks [20,21].…”

Facile fabrication of diatomite‐based sponge with high biocompatibility and rapid hemostasis

“…Excessive bleeding after traumatic injury is the major cause of death in the military and in civilian medicine. [1][2][3] To control the hemorrhage, several topical hemostats based on organic polymers and inorganic microÀ/nanometer materials have been developed. These hemostatic agents possess porous structure that can concentrate blood coagulation factors and platelets on the wound through quick water absorption to promote blood clotting.…”

The continuum of critical care

“…Pre-hospital trauma management, including major disasters, is perhaps the area where most improvement has been seen in recent years, often as a result of lessons learned from the military arena being transferred to the civilian setting [5]. Rapidly dispatched trauma teams, often including medical personnel, provide early on-site resuscitation and stabilization.…”