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MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS

MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS. CDR JOHN P. WEI, USN MC MD 4 th Medical Battallion, 4 th MLG, BSRF-12. MILITARY MASS CASUALTIES. Long protracted event Extensive locally or at battlefield Variable number of injured or dead

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MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS

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  1. MILITARY TRIAGE AND EVACUATION: PARALLELS TO CIVILIAN SYSTEMS CDR JOHN P. WEI, USN MC MD 4th Medical Battallion, 4th MLG, BSRF-12

  2. MILITARY MASS CASUALTIES • Long protracted event • Extensive locally or at battlefield • Variable number of injured or dead • Health facilities always ready to receive injured • Resources potentially unlimited • Natural and geographic limitations • Usually occurs on foreign soil

  3. MILITARY CARE FOR BATTLEFIELD CASUALTIES • Save lives • Reduce permanent morbidity and deficits • Return fighting force to battlefront • Evacuate casualties for definitive care

  4. STANDARD TRIAGE • Provide orderly care to those who need most urgently • Save most number of lives • Coded system: • Green: minor injuries • Yellow: major injuries, acceptable for delayed care • Red: major injuries, require immediate treatment • Black: expectant

  5. MILITARY CARE FOR BATTLEFIELD CASUALTIES • Depend upon battlefield conditions Urban 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

  6. 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

  7. DIFFERENTIATED LEVELS OF 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

  8. 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

  9. CASUALTY EVACUATION • Casualty evacuation via ground ambulance CASEVAC • Difficult terrain • Remote location • Medical evacuation MEDEVAC • Air rescue by Blackhawk/Seahawk or Chinook helicopter

  10. ECHELON II Forward surgical capability Mobile combat support hospital Basic surgical capacity to save lives

  11. ECHELON III Fixed brick/mortar hospital with ICU capacity, advanced radiology, neurosurgical & orthopedic capability

  12. AEROMEDICAL EVACUATION Critical care transport in air Transcontinental evacuation Transport of mass casualties Provision of sophisticated ICU care while en route

  13. ECHELON IV Landstuhl Regional Medical Center, Germany Intermediate advanced surgical care for stabilization Intensive care unit provisions

  14. ECHELON V Definitive care for battle injuries Recuperation in CONUS Walter Reed MC, Bethesda NMC, Brooke AMC

  15. CIVILIAN MASS CASUALTIES • Acute isolated event • Extensive destruction • Large number of ill, injured, or dead • Health facilities overwhelmed by ill or injured • Resources damaged or limited • Natural and Geologic • Weather and Atmospheric • Biologic and Infectious • Terrorist Acts • Man-made Accidents • Catastrophes

  16. CIVILIAN HOSPITAL PREPAREDNESS • Emergency practice drills • Hospital planning • Variability • In trained personnel • Integration with local EMS • Liason with municipalities

  17. 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 SYSTEMS

  18. 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

  19. CIVILIAN TRAUMA SYSTEM Emergency first responders: variable ambulance services dependent on municipality, private services, hospital BLS/EMT vs. advanced care with paramedics

  20. 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

  21. 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

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