Civilian versus Military Trauma Management
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1 Western University From the SelectedWorks of Vivian C. McAlister November, 2010 Civilian versus Military Trauma Management Vivian C. McAlister Available at:
2 SOUTHWESTERN ONTARIO SURGICAL ASSOCIATION ANNUAL MEETING 12 Nov 2010 Civilian versus Military Trauma Management Vivian McAlister University of Western Ontario Canadian Forces Medical Service
3 In the 21st century, military and civilian trauma surgeons bring similar solutions to similar problems, learning one from another
4 Pelvic-gluteal hemorrhage: personal observations Open blast injuries more common in war Ipsilateral internal iliac artery ligation very useful in open injuries to groin, pelvis and buttock Extraperitoneal approach to internal iliac artery quickest route to ligation and allows packing Ligation in continuity preferable to angioembolization
5 Pelvic-gluteal hemorrhage Bilateral Internal Iliac Artery Ligation as a Damage Control Approach in Massive Retroperitoneal Bleeding After Pelvic Fracture. Dubose J, Inaba et al. J Trauma 2010 May (e-pub) Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. Cothren CC et al. J Trauma 2007 Apr;62(4):834-9
6 Objective: review military trauma care in Afghanistan / Iraq for aspects that may influence civilian practice at home Comprehensive trauma care system: guidelines, registry, review Protocols for care: damage control; massive blood transfusion policy; mass casualty care Techniques: resuscitative thoracotomy; decompressive craniectomy; pelvic-gluteal hemorrhage control Rehabilitation: Mild traumatic brain injury Delegated medical acts: medics / PAs
7 Eastman AB. J Am Coll Surg Aug;211(2):
8 This military trauma system provides a model for our civilian systems in this country Eastman AB. J Am Coll Surg Aug;211(2):
9 Joint Theater Trauma System Developed by United States Army Institute of Surgical Research to reduce mortality and morbidity of trauma to its lowest levels Clinical practice guidelines JTTR Weekly teleconference Search: JTTS CPG
10 CPG: not a substitute for clinical judgment Acoustic Trauma and Hearing Loss Amputation Blunt Abdominal Trauma Burn Care Catastrophic Care Cervical Spine Evaluation Compartment Syndrome / Fasciotomy Nutrition Damage Control Resuscitation Emergent Resuscitative Thoracotomy Fresh Whole Blood (FWB) Transfusion Frozen Blood Hypothermia Prevention Infection Control Ocular and Adnexal Injuries Transfer and Trauma Patients Severe Head Trauma Management of War Wounds Pelvic Fracture Care Post Splenectomy Vaccination Prevention of Deep Venous Thrombosis (DVT) Spine Injury Surgical Management and Transport Trauma Airway Management Urologic Trauma Management Use of Electronic Documentation Use of Trauma Flow Sheets VAP Inhalation Injury and Toxic Industrial Chemical Exposure
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15 Thurs 15 Sep 2011 Postgraduate course: Mass Casualty Exercise Participants from all disciplines incl. local hospital nurses, technicians and directors Based on CF training exercise: Maple Guardian Medical student participants and role-players 1911 London Ontario: Canadian Army Medical Corps holds its first exercise Faculty to learn observercontroller-trainer role Goal to develop a travelling course
16 Rehabilitation from stress and injury Begins in the field Involves the unit and the family Goal is to restore the injured patient to productivity within the organization Requires expertise and transparency
17 MTBI: mild traumatic brain injury
18 Overlapping symptoms of PTSD, mtbi and depression Headache Lack of concentration Difficulty learning Irritability Sleep disorder
19 Iron Mike Webster
20 Response to mtbi (concussion) Compulsory screening of injured and also soldiers associated with event Compulsory rest 1st episode: 'Take a knee' 3 day rest 3 counts and your out
21 E. Harvey Estes and Eugene A Stead, Jr begin the physician assistant training program in USA after the Vietnam War.
22 Delegated medical tasks Self care / buddy care Who should be trauma team leaders: consultants (British Army) or physician assistants (CF) Medical technicians: 'Stop and treat' versus 'scoop and run' Which interventions are useful? tourniquet, surgical airway, needle decompression
23 HIPPOCRATES (ca. 460 BC ca. 370 BC) British Museum, second or third century B. C.
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Principles of combat surgical care in a staged evacuation system
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