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Abstract
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Violence from explosives and firearms results in mass casualty events in which the injured have multiple penetrating and soft tissue injuries. Events such as those in Boston, Massachusetts; Newtown, Connecticut; and Aurora, Colorado, as well as those in other locations, such as Europe and the Middle East, demonstrate that civilian trauma may at times resemble that seen in a combat setting. As the civilian sector prepares for and responds to these casualty scenarios, research and trauma practices that have emerged from the wars in Afghanistan and Iraq provide a valuable foundation for responding to civilian mass casualty events. Several lessons learned by the US military were implemented during the response to the bombings in Boston in April of this year.
Military research has found that approximately 25% of persons who die as a result of explosive or gunshot wounds have potentially survivable wounds.1 These individuals have injuries that are not immediately or necessarily lethal and have a chance to survive if appropriate care is rendered in a timely fashion. The military has learned that implementation of evidence-based, clinical practice guidelines can reduce potentially preventable death.2 Certain aspects of these lessons also apply to multiple casualty scenarios in civilian settings.
The care of wounded military service personnel is based on an integrated trauma system and involves timely point-of-injury intervention, coordinated patient transport, whole blood or blood component-based resuscitation, and initial operating focused on control of hemorrhage and optimizing patient physiology. Referred to as damage control surgery, this approach involves abbreviated techniques instead of longer definitive operations. The principles of combat casualty care should be considered in 3 phases: point of injury, during transport to the hospital, and hospital-based treatment. The wars have highlighted the importance of a trauma system to coordinate these phases and improve survival. In implementing this strategy, the military developed the Joint Trauma System, which is designed to provide wounded troops an optimal chance for survival and recovery.... |