Vascular Trauma: The Military and Civilian Perspective
Military and civilian medicine have learned a great deal from each other, sharing medical products, techniques, and concepts but current research states that additional training is still needed to better understand the most effective methods as well as how and when to administer those methods. To better understand how we can achieve that goal is the reason that we have come together at the 2011 Advanced Technology Applications for Combat Casualty Care conference. While the setting and the mission may be different for these two groups, the goal is ultimately the same -- to save lives.
According to a presentation given Tuesday morning by Daniel Scott, a surgical resident at the San Antonio Military Medical Center, vascular injuries contribute significantly to battlefield morbidity and mortality. In fact, a 2003-2004 study, states that hemorrhage remains the leading cause of preventable battlefield death. In the civilian world, it is estimated to be between four and 12 cases of vascular trauma each year at hospitals and trauma centers throughout the world.
The military is knowledgeable in vascular trauma in terms of prevention and treatment. According to Scott, force protection measures (such as body armor), consistent use of evidence based clinical practice guidelines and rapid medical evacuation systems with discrete levels of care mean that those injured in combat are three times as likely to survive after major arterial vascular injury than those with similar injuries in the civilian setting.
However, there is a still much to be learned - the techniques and equipment used in both settings are relatively similar but training must be conducted to ensure an overall knowledge of stents, shunts, and catheters. Additionally more information is needed on topics such as blood pressure and fluids to ensure that certain medical countermeasures are being administered correctly. According to presenter Ken Mattox, "if there is a deficit, it is in training," he goes on to state that "simulation is part of the solution." There must be integrated, cooperative training between the military medical community and our civilian counterparts to ensure that we are offering the best standard of care to all patients and learning the most that we can from each other.