U.S. Military Medical Evacuation and Prehospital Care of Pediatric Trauma Casualties in Iraq and Afghanistan

Naylor, Jason F; April, Michael D.; Thronson, Erick E; Hill, Guyon J.; Schauer, Steven G

doi:10.1080/10903127.2019.1626956

Cited by 5 publications

(3 citation statements)

References 33 publications

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“…The total denominator remains unclear. Of the pediatric encounters between 2007 and 2016, approximately 30% underwent evacuation from the point of injury with 90.7% via standard medical evacuation platforms and 9.3% by nonstandard platforms 13 …”

Section: Discussionmentioning

confidence: 99%

“…Of the pediatric encounters between 2007 and 2016, approximately 30% underwent evacuation from the point of injury with 90.7% via standard medical evacuation platforms and 9.3% by nonstandard platforms. 13 A majority of research identifies that males receive drug administrations and procedural interventions more often with percentages ranging 77% to 80%. 5,10,14 Gale et al 14 found that females are less likely to sustain injuries via explosives (38.0% vs. 44.5%) or have serious injuries to the thorax and extremities.…”

Section: Discussion Epidemiologymentioning

confidence: 99%

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A scoping review of two decades of pediatric humanitarian care during wartime

Kocik

Borgman

April

et al. 2023

J Trauma Acute Care Surg

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Humanitarian care is a vital component of the wartime mission. Children comprise a significant proportion of casualties injured by explosives and penetrating weapons. Children face a variety of unique injury patterns in the combat setting as high-powered firearms and explosives are rarely seen in the civilian setting. We sought to perform a scoping review of pediatric research from the recent US-led wars in Afghanistan, and Iraq conflicts beginning in 2001. We used Google Scholar and PubMed to identify pediatric combat literature published between 2001 and 2022. We utilized the PRISMA-ScR Checklist to conduct this review. We identified 52 studies that met inclusion for this analysis—1 prospective observational study, 50 retrospective studies, and 1 case report. All the original research studies were retrospective in nature except for one. We identified one prospective study that was a post hoc subanalysis from an overall study assessing the success of prehospital lifesaving interventions. Most of the articles came from varying registries created by the United States and British militaries for the purposes of trauma performance improvement. The deployed health service support mission often includes treatment of pediatric trauma patients. The deployed health service support mission often includes treatment of pediatric trauma patients. We found that available literature from this setting is limited to retrospective studies except for one prospective study. Our findings suggest that pediatric humanitarian care was a significant source of medical resource consumption within both of the major wars. Further, many of the lessons learned have directly translated into changes in civilian pediatric trauma care practices highlighting the need for collaborative scientific developments between the military and civilian trauma programs. LEVEL OF EVIDENCE Systematic Review/Meta-Analyses; Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussion Epidemiologymentioning

confidence: 99%

A scoping review of two decades of pediatric humanitarian care during wartime

Kocik

Borgman

April

et al. 2023

J Trauma Acute Care Surg

Self Cite

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“…93 children were assisted by improvised means -applying other types of harnesses, improvised turnstiles, providing intravenous access. The results of the study indicate that the survival rate among groups of children was 88.1% and 89.2%, respectively [8].…”

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confidence: 88%

Management Tactics for Bleeding in Children With Military Trauma: Literature Data

Pokhylko¹,

Adamchuk²,

Cherniavska³

et al. 2022

Neonatol. hìr. perinat. med.

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The civilian population always suffers during hostilities. There are modern protocols for emergencymedical care for military trauma in adults. However, for children, there are no approved guidelines, especially forthe management of bleeding. Trauma is the leading cause of death between the ages of 1 and 19, with blood lossaccounting for 40% of all deaths from injury. Regarding the causes of death during the war, bleeding accounted for80%. Limb circumference in children is usually much smaller than in adults, which calls into question the abilityof a standard turnstile to effectively stop bleeding in a child. Many turnstiles have a rigidly fixed mechanicalclamping system (such as a windlass or ratchet), which eliminates their effectiveness in applying to the limb with acircumference less than expected. Also, the pressure of the mechanical windlass system for children can be excessiveand lead to complications. However, there is reliable data on the effective classic application of the tactical turnstileСAT in children aged 1 year with a circumference of the limb of at least 13 cm and can be used by a medicalprofessional of any qualification. It is allowed to use the СAT turnstile in children from 3 months of age, but theapplication technique requires modification and experience of a medical professional. When stopping bleeding,children under 2 years of age are recommended to start with direct pressure on the wound, and only if ineffectiveor impossible pressure to apply a tourniquet to the limb above the wound, or tamponade the wound with nodularbleeding. However, in any case, in the presence of massive bleeding from the limb or amputation of the limb, theprimary method of stopping bleeding is currently the imposition of a tactical turnstile САТ.

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