INJURY MECHANISM RETROSPECTIVE COMPARISON

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Army Medicine Advances in Combat Casualty Care
MG Robert J. Kasulke MD MPA FACS Deputy Surgeon
General, Mobilization, Readiness and Reserve
Affairs (USAR)
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Agenda today

• Medical Lessons Learned
• Changes made
• Capabilities of Medical Personnel
• What you need to know
• TBI/PTSD
• Battlemind Training
• Suicide

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To Conserve Fighting Strength
Army Wounded, Ill Injured in OEF/OIF 1 January
200330 May 2007
Return to Duty
90
23
67
10
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DEPLOYED FORCE
MEB
PEB
CONUS MTF
AVG 72Hrs
IN THEATRE
AVG 99 days
AVG 3 days
AVG 76 days
LRMC
AVG 197 days
Medically Separated
90
10
33
77
93
BI NBI Disease
CONUS
Med Transport
48 to 72 Hrs
Average 378 days
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Transformation in Casualty Care Survivability

• Body Armor
• Enhanced Trauma skills of the 68W
• Far forward Resuscitative Surgical Care
• Rapid Evacuation by air

• 2005 Data Directorate for Information
  Operations and Reports

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Injury Patterns on the Battlefield
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Injuries by Type
Non-Battle
Battle
39
61
Source JTTR September 2001 to 8-Jun-2007
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Cause of Injuries
Explosives
Other 4
Battle
Soldiers IED
3598 Hand grenade
755 Mortar/Rocket 599 Explosive Fragment
138 Mine/Landmine 175
Firearms 19
Explosives
77
Non-Battle
All Other
MVC
21
41
8
14
10
6
Struck by /Against
Machinery
Overexertion
Falls
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Preventable Causes of Death

• Primary focus on hemorrhage control
• Extremity hemorrhage (9)
• Non-extremity hemorrhage
• Tension pneumothorax (penetrating chest wounds)
  (5)
• Airway compromise (1)

15 of battlefield deaths are preventable
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Hemorrhage Control

• Dressings
• Trauma Wound Dressings
• Hemostatic Dressings
• HemCon (Chitosan)
• Quickclot
• Tourniquets
• Combat Application Tourniquet
• Myths

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Tension Pneumothorax
Air between lung and chest wall
Air collapses lung and pushes heart to other side
Blood return to heart restricted by kinked
vessels, heart unable to pump
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Needle Decompression
Identify the 2nd rib, 2nd intercostal space, and
the mid-clavilicular line (center of the collar
bone). 
Insert the needle just over the 3rd rib, through
the intercostal muscles and into the chest
cavity.
A "hiss" of air confirms the presence of
pneumothorax and is effective treatment for it.
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IFAK Component Stowage
2 Tape
Combat Application Tourniquet (CAT)
Stored on Outside of
Insert
Trauma Dressing
28 French Nasopharyngeal Airway (NPA)
Kerlix
NOT TO SCALE
Exam Gloves (4)
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Combat Lifesavers are primarily shooters, not
junior medics. They should be trained to treat
the most common causes of preventable death as
the tactical situation allows.
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Skill Levels for Point of Wounding Providers
Core Skills
CLS
Medic
Clear an upper airway obstruction
X
X
Perform CPR
X
X
Insert an nasopharyngeal airway
X
X
Perform a surgical cricothyridotomy
X
Perform a trauma casualty assessment
/-
X
Control bleeding using pressure dressings
X
X
Apply a tourniquet to control active bleeding
X
X
Recognize signs and symptoms of shock
X
X
Start an intravenous infusion
X
X
Perform needle chest decompression
X
X
Initiate an intraosseous infusion
X
Recognize cardiac arrest / defibrillation with AED
/-
X
Splint extremity fractures
X
X
Evaluate and provide initial treatment for burns
/-
X
Perform initial triage of casualties
/-
X
Request medical evacuation
X
X
International Humanitarian Law / Detainee Care
X
Minor Surgical Procedures
X
Emergency Surgical Procedures
X
Blast Injuries
X
Tactical Combat Casualty Care Concepts
X
X
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Combat Life Saver

• New Three Day Curriculum
• -Incorporates Tactical Combat Casualty Care
  principles
• -Evaluate a Casualty
• -Manage a Casualtys Airway (NPA)
• -Treat Penetrating Chest Trauma
• Decompress a Tension Pneumothorax (NCD)
• -Control Bleeding (Tourniquet-Emergency
  Dressing)
• -Initiate a Saline Lock / Intravenous Infusion
• -Initiate a Field Medical Card
• -Request Medical Evacuation (MEDEVAC)
• -Evacuate a Casualty using a SKED or Improvised
  Litter
• Promotion Points (8)

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68W Medic Sustainment

• Annual Requirements
• Required for MOS Qualification
• 24 hours Combat Trauma training
• 4 hours airway assessment and skills training
• 4 hours IV access and medication training
• 6 hours patient assessment and treatment training
• 4 hours triage and evacuation training
• 4 hours CPR training (optional)
• 2 hours OB/GYN and pediatric training
• 48 hours of training per year

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mTBI and PTSD

• Mild Traumatic Brain Injury and Post Combat
  Stress Disorder have become known as the
  signature combat injuries associated with
  current and ongoing Global War on Terrorism
  (GWOT) operations.
• ALARACT 153-2007 provided information and
  resources on concussions and Post Combat and
  Operational Stress.
• http//www.pdhealth.mil/downloads/Mild_TBI_PTSD_Fa
  cilitators_Guide_2007.pdf

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EXPERIENCE

• For they had learned that true safety was to be
  found in long previous training, and not in
  eloquent exhortations uttered when they were
  going into action.
• Thucydides
• The Peloponnesian War

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• It is the difficulties which show what men are.
• Epitectus

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Questions??