The provision of sophisticated critical care beyond the hospital: Lessons from physiology and military experiences that apply to civil disaster medical response

Abstract

The U.S. Air Force CCAT Team program, as well as many civilian critical care air ambulance services, provides a workable starting point for the development of disaster medical critical care response capabilities for disaster medical systems.

Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for research and practice

“…In the present conflicts, evacuation of the wounded has been greatly accelerated with wounded soldiers arriving in a major military hospital (i.e., Landstuhl Regional Medical Center, Germany) in some cases <24 hours postinjury. Seriously wounded soldiers who likely would not have survived in previous wars are now routinely saved because of rapid air evacuation to the United States via critical-care Aeromedical Transport Teams [6]. In this environment, the goal of field medicine is stabilization of the patient for rapid transport to the next level of care and traditional intravenous morphine pain protocols have limited usefulness.…”

“…Nevertheless, despite the number of casualties and the wound severity, the U.S. military medical system has been remarkably successful in the management of combat trauma during these conflicts, as evidenced by the >90 percent survival rate following injury [2]. This success has been attributed to multiple factors, including improved body armor [3][4], surgical care deployed far forward on the battlefield [5], and rapid evacuation to major hospitals via military aircraft equipped with sophisticated medical equipment [6]. The advantages of these innovations for survival following combat trauma are clear, but this success has created other unforeseen medical challenges.…”

The 2004 Fitts Lecture: Current Perspective on Combat Casualty Care

“…The U.S. Air Force critical care air transport (CCATT) teams are making this happen. 42,43 They make it look easy, but I cannot stress the importance of the overall evacuation effort. The ISR Burn Team likewise frequently links with the CCATT teams and routinely brings patients back to the Burn Center in San Antonio, Texas, within 2 to 3 days of injury.…”

Emergent Interfacility Evacuation of Critical Care Patients in Combat

“…In 1994, after Gulf War I, the Air Force developed mobile critical care teams called Critical Care Aeromedical Transport teams in response to an unmet military need for long-range air evacuation of critically ill and injured patients. 11 The teams usually consist of an intensivist physician, a critical care nurse, and a respiratory therapist. 12 This solved the "out of the war zone" evacuation of critical patients, but did not address the interfacility or intratheater evacuation of patients, most of who were still transferred with a single EMT-B combat medic in attendance.…”