Pediatric trauma: experience of a combat support hospital in Iraq

McGuigan, Rebecca; Spinella, Philip C.; Beekley, Alec C.; Sebesta, James A.; Perkins, Jeremy G.; Grathwohl, Kurt W.; Azarow, Kenneth S.

doi:10.1016/j.jpedsurg.2006.09.020

Cited by 62 publications

(63 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4,5,17 Improvement in the use of pediatrics-trained personnel, pediatric medications, and pediatric equipment has been called for by service members deployed in both Afghanistan and Iraq. 8,9,18,19 The US Army Medical Command response to the increased load of pediatric patients has included pediatrics-specific trauma training for all hospital personnel before deployment; development and support of a pediatric critical care telemedicine service that provides immediate access via telephone to a pediatric intensivist or neonatologist at all times and that is available to all deployed physicians; development of a complete pediatric medical supply and medication package that augments the supplies of military medical treatment facilities; and deployment of pediatricians and pediatrics-trained personnel to the busiest CSHs.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

Burnett¹,

Spinella

Azarow

et al. 2008

Pediatrics

Self Cite

View full text Add to dashboard Cite

Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. RESULTS. Pediatric admissions during the study period were 1012 (4.2%) of 24 227 admissions, occupying 10% of all bed-days. The median length of stay was 4 days (interquartile range: 1-8 days). The largest proportion of children were 11 to 17 years of age (332 of 757 children; 44%), although 45 (6%) of 757 children hospitalized were Ͻ1 year of age. The majority (63%) of pediatric patients admitted required either general surgical or orthopedic procedures. The in-hospital mortality rate for all pediatric patients was 59 (5.8%) of 1012 patients, compared with 274 (4.5%) of 6077 patients for all adult non-US coalition patients.CONCLUSIONS. Pediatric patients with injuries threatening life, limb, or eyesight are part of the primary responsibility of military medical facilities during combat and have accounted for a significant number of admissions and hospital bed-days in deployed Army hospitals in Afghanistan and Iraq. Military medical planners must continue to improve pediatric medical support, including personnel, equipment, and medications that are necessary to treat children injured during combat operations, as well as those for whom the existing host nation medical infrastructure is unable to provide care. I N WARTIME, CHILDREN are injured and killed. This tragedy is neither new nor unique to the current conflicts in Afghanistan and Iraq. The circumstances and conduct of this war are unique, however, because the strategy for the war calls for more than the destruction of a fixed definable enemy. The US national security strategy includes "expanding the circle of development" by working with the governments to, among other things, "invest in health care." 1,2 Pediatric patients represent significant proportions of the health care needs in Afghanistan and Iraq, and their treatment must be included if this national security strategy is to be successful.When large-scale conflict has ended but security for civilians cannot be guaranteed, nation-building responsibilities that normally would be met by civilian governmental and nongovernmental organizations fall to the uniformed services by necessity. 3 The same military forces that are engaged in combat one day must maintain stability the next day, while suppo...

show abstract

Section: Discussionmentioning

confidence: 99%

Pediatric Care as Part of the US Army Medical Mission in the Global War on Terrorism in Afghanistan and Iraq, December 2001 to December 2004

Burnett¹,

Spinella

Azarow

et al. 2008

Pediatrics

Self Cite

View full text Add to dashboard Cite

show abstract

“…Depending on the phase of war, the relative proportion of pediatric patients presenting with burn injury ranged from 8 to 56 %, frequently combined with multiple other injuries as a result of explosion or blast [50]. Mortality was highest when burn injury was combined with head injury or inhalational injury [51].…”

Section: Burn Injurymentioning

confidence: 99%

Pediatric Combat Trauma

Russo

Neff

2016

Curr Trauma Rep

View full text Add to dashboard Cite

Purpose of review Military physicians have amassed tremendous experience treating children with combat-related injuries in Iraq and Afghanistan. This review will present several treatment principles adapted from adult trauma care that were applied to children in war and consider their selective application in civilian practice. Recent findings Many standard practices of adult trauma care were applied to the management of war-injured children. Initial reports of tourniquet use, tranexamic acid administration, and balanced blood transfusion suggest a benefit to the pediatric population. Constraints of providing intensive care in an austere environment required a shift in management toward aggressive limb salvage over amputation, and early palliation for severe brain injury or extensive burns.Summary Despite the obstacles that may limit the direct translation of trauma care principals to civilian settings, these wartime experiences offer robust and excellent preliminary data that might inform future investigations in the field of pediatric trauma care.

show abstract

“…[5][6][7][8][9] Many pediatric patients were eligible for care at the R3-MMU by meeting the criteria of a battle injury or exceeding the capabilities of the Afghan local national facilities. Of this population, more than one-quarter were children younger than 6 years.…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion of pediatric staff by the USNMC was the result of feedback from earlier missions. 5,11 Pediatric trauma patients often required considerable resources for their care, including critical care interventions such as mechanical ventilation and ward care. Members of the patient's family would also be allowed to stay with them and had to be fed and sheltered at the R3-MMU.…”

Section: Discussionmentioning

confidence: 99%