MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS CDR JOHN P. WEI, USN MC MD 4 th...
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Transcript of MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS CDR JOHN P. WEI, USN MC MD 4 th...
MILITARY TRIAGE AND EVACUATION: PARALLELS
TO CIVILIAN SYSTEMS
CDR JOHN P. WEI, USN MC MD4th Medical Battallion, 4th MLG, BSRF-12
MILITARY MASS CASUALTIES
Long protracted eventLong protracted event Extensive locally or at battlefieldExtensive locally or at battlefield Variable number of injured or deadVariable number of injured or dead Health facilities always ready to receive injuredHealth facilities always ready to receive injured Resources potentially unlimitedResources potentially unlimited Natural and geographic limitationsNatural and geographic limitations Usually occurs on foreign soilUsually occurs on foreign soil
MILITARY CARE FOR MILITARY CARE FOR BATTLEFIELD CASUALTIESBATTLEFIELD CASUALTIES
Save livesSave lives Reduce permanent morbidity and deficitsReduce permanent morbidity and deficits Return fighting force to battlefrontReturn fighting force to battlefront Evacuate casualties for definitive careEvacuate casualties for definitive care
STANDARD TRIAGESTANDARD TRIAGE Provide orderly care to those who need most Provide orderly care to those who need most
urgentlyurgently Save most number of livesSave most number of lives Coded system:Coded system: Green: minor injuriesGreen: minor injuries Yellow: major injuries, acceptable for delayed Yellow: major injuries, acceptable for delayed
carecare Red: major injuries, require immediate Red: major injuries, require immediate
treatmenttreatment Black: expectantBlack: expectant
MILITARY CARE FOR BATTLEFIELD CASUALTIES
• Depend upon battlefield conditionsUrban vs rural mountainous terrain
• Small arms fire vs. explosive devices• Geography of battlefield• Dedicated resources available on site• Health care system primary mission
is treatment of casualties
CARE OF BATTLEFIELD CASUALTIES
Stratified to provide immediate access to basic care
Stabilization in the battle field Progressive levels of evacuation to
advanced care in rear Evacuation to homeland for
definitive care & recovery
DIFFERENTIATED LEVELS DIFFERENTIATED LEVELS OF CAREOF CARE
Echelon I: Buddy-aid, corpsman/medic, First-Aid Station
Echelon II: FST / FRSS field support hospital with surgical capacity
Echelon III: fixed base advanced care hospital
Echelon IV: complex advanced stabilization and care
Echelon V: definitive CONUS hospital
ECHELON I
Buddy-aid: every soldier carries tourniquet, QuikClot pack
Medic/Corpsman – first aid pack with I.V.'s RL, bandages, needles
First Aid Station: if available, GMO / ER physician
CASUALTY EVACUATION
Casualty evacuation via ground ambulance CASEVAC– Difficult terrain– Remote location
Medical evacuation MEDEVAC– Air rescue by Blackhawk/Seahawk or
Chinook helicopter
ECHELON II
Forward surgical capability
Mobile combat support hospital
Basic surgical capacity to save lives
ECHELON III
Fixed brick/mortar hospital with ICU capacity, advanced radiology, neurosurgical & orthopedic capability
AEROMEDICAL EVACUATION
Critical care transport in air Transcontinental evacuation Transport of mass casualties Provision of sophisticated ICU care while
en route
ECHELON IV
Landstuhl Regional Medical Center, Germany
Intermediate advanced surgical care for stabilization
Intensive care unit provisions
ECHELON V
Definitive care for battle injuries Recuperation in CONUS Walter Reed MC, Bethesda NMC,
Brooke AMC
CIVILIAN MASS CASUALTIES Acute isolated eventAcute isolated event Extensive destructionExtensive destruction Large number of ill, injured, or deadLarge number of ill, injured, or dead Health facilities overwhelmed by ill or injuredHealth facilities overwhelmed by ill or injured Resources damaged or limitedResources damaged or limited Natural and GeologicNatural and Geologic Weather and AtmosphericWeather and Atmospheric Biologic and InfectiousBiologic and Infectious Terrorist ActsTerrorist Acts Man-made AccidentsMan-made Accidents CatastrophesCatastrophes
CIVILIAN HOSPITAL PREPAREDNESSCIVILIAN HOSPITAL PREPAREDNESS
Emergency practice drillsEmergency practice drills Hospital planningHospital planning VariabilityVariability In trained personnelIn trained personnel Integration with local EMSIntegration with local EMS Liason with municipalitiesLiason with municipalities
CIVILIAN TRAUMA SYSTEMSCIVILIAN TRAUMA SYSTEMS
American College of Surgeons Committee on Trauma
Training of personnel Physical capacity and capability Triage of patients by severity of
injuries to designated centers: Level I, II, III
CIVILIAN TRAUMA SYSTEM
Geographically dependent on resources
No dedicated resources at all levels Not all hospital facilities are trauma
capable No dedicated trauma/critical care
personnel
CIVILIAN TRAUMA SYSTEM
Emergency first responders: variable ambulance services dependent on municipality, private services, hospital
BLS/EMT vs. advanced care with paramedics
CIVILIAN TRAUMA SYSTEM
Air evacuation via helicopter limited to Level I centers with air services
Limitations of time and distance Severity of injuries Access to Level I care
SUMMARY
Current civilian trauma system takes origin from military experience
Battlefield mass casualties demand different resources and capabilities
Principles of triage and evacuation similar between military and civilian systems
Military system dedicated to trauma care as primary mission