Battlefield medicine

An illustration showing a variety of wounds from the Feldbuch der Wundarznei (Field manual for the treatment of wounds) by Hans von Gersdorff, (1517); illustration by Hans Wechtlin.

Battlefield medicine, also called field surgery and later combat casualty care, is the treatment of wounded combatants and non-combatants in or near an area of combat. Civilian medicine has been greatly advanced by procedures that were first developed to treat the wounds inflicted during combat. With the advent of advanced procedures and medical technology, even polytrauma can be survivable in modern wars. Battlefield medicine is a category of military medicine.

Chronology of medical advances on the battlefield

• During the Battle of Shrewsbury in 1403, Prince Henry had an arrow removed from his face using a specially designed surgical instrument.
• Ambulances or dedicated vehicles for the purpose of carrying injured persons. These were first used by Spanish soldiers during the Siege of Málaga (1487).
• French military surgeon Ambroise Paré (1510–90) pioneered modern battlefield wound treatment. His two main contributions to battlefield medicine are the use of dressing to treat wounds and the use of ligature to stop bleeding during amputation.
• American Revolutionary War: Many surgeons during this time were not licensed practicing physicians, 400 out of 3,500 doctors were fully licensed, in fact only two universities offered medical degrees which was King's College in New York, and the College of Philadelphia. At this time there were very few doctors that had equal knowledge as their European counterparts. They also were not able to produce many remedies for illnesses, only scurvy, malaria, and smallpox. Most deaths occurred not from battle injuries, but from surgeries because of not knowing the proper techniques and not having proper sterilization. One study shows that around 50% of surgeries were fatal.
• The practice of triage pioneered by Dominique Jean Larrey during the Napoleonic Wars (1803–1815). He also pioneered the use of ambulances in the midst of combat ('ambulances volantes', or flying ambulances). Prior to this, military ambulances had waited for combat to cease before collecting the wounded by which time many casualties would have succumbed to their injuries.
• Russian surgeon Nikolay Ivanovich Pirogov was one of the first surgeons to use ether as an anaesthetic in 1847, as well as the very first surgeon to use anaesthesia in a field operation during the Crimean War.
• American Civil War surgeon Jonathan Letterman (1824–72) originated modern methods of medical organization within armies.
• Advances in surgery - especially amputation, during the Napoleonic Wars and First World War on the battlefield of the Somme.
• During the Spanish Civil War there were two major advances. The first one was the invention of a practical method for transporting blood. Developed in Barcelona by Duran i Jordà, the technique mixed the blood of the donors with the same blood type and then, using Grífols glass tubes and a refrigerator truck, transported the blood to the frontline. A few weeks later Norman Bethune developed a similar service. The second advance was the invention of the mobile operating room by the Catalan Moisès Broggi, who worked for the International Brigades.^[1]
• The establishment of fully equipped and mobile field hospitals such as the Mobile Army Surgical Hospital was first practiced by the United States in World War II. It was succeeded in 2006 by the Combat Support Hospital.
• The use of helicopters as ambulances, or MEDEVACs was first practiced in Burma in 1944. The first medivac under fire was done in Manila in 1945 where over 70 troops were extracted in five helicopters, one and two at a time.
• The extension of emergency medicine to prehospital settings through the use of emergency medical technicians.
• The use of remote Physiological Monitoring Devices on soldiers to show vital signs and biomechanical data to the medic and MEDEVAC crew before and during trauma. This allows medicine and treatment to be administered as soon as possible in the field and during extraction.

The term "Meatball surgery" is a term used in battlefield medicine to refer to surgery that is meant to be performed rapidly to stabilize the patient as quickly as possible.

A US Army soldier, wounded by a Japanese sniper, undergoes surgery during the Bougainville Campaign in World War II.

Current Battlefield Medicine used by the U.S. Military

Over the past decade combat medicine has improved drastically. Everything has been given a complete overhaul from the training to the gear. In 2011, all enlisted military medical training for the U.S. Navy, Air Force, and Army were located under one command, the Medical Education and Training Campus (METC). After attending a basic medical course there (which is similar to a civilian EMT course), the students go on to advanced training in Tactical Combat Casualty Care.^[2]

Tactical Combat Casualty Care

Today, TCCC is becoming the standard of care for the tactical management of combat casualties within the Department of Defense and is the sole standard of care endorsed by both the American College of Surgeons and the National Association of EMT's for casualty management in tactical environments.^[3]

TCCC is built around three definitive phases of casualty care:

1. Care Under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic. This stage focuses on a quick assessment, and placing a tourniquet on any major bleed.
2. Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours. Care here may include advanced airway treatment, IV therapy, etc. The treatment rendered varies depending on the skill level of the provider as well as the supplies available. This is when a corpsman/medic will make a triage and evacuation decision.
3. Tactical Evacuation Care (TACEVAC): Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.^[4][5]

Since "90% of combat deaths occur on the battlefield before the casualty ever reaches a medical treatment facility" (Col. Ron Bellamy) TCCC focuses training on major hemorrhaging, and airway complications such as a tension-pneumothorax. This has driven the casualty fatality rate down to less than 9%.^[6][7]

See also

• Military medicine
• Medical Corps
• Combat medic
• Aid station
• Combat support hospital
• Ambulance#Military use
• History of medicine
• Polytrauma
• Timeline of medicine and medical technology
• Textbook of Military Medicine
• Remote physiological monitoring
• Medical Education and Training Campus
• CASEVAC
• National Association of Emergency Medical Technicians

Citations

1. Solé & Camarasa 2015, p. 38-39.
2. "METC Online". Retrieved 29 December 2014.
3. http://www.naemt.org/education/TCCC/guidelines_curriculum.aspx
4. "Tactical Combat Casualty Care (TCCC)". Retrieved 29 December 2014.
5. "Causes of Death in U.S. Special Operations Forces in the Global War on Terrorism". Retrieved 29 December 2014.
6. http://www.drum.army.mil/tenants/Documents/C191W1TC%20CMAST%20-%20Point%20of%20Wounding%20Care.ppt
7. "Tactical Combat Casualty Care (TCCC)". Retrieved 29 December 2014.

Bibliography

• Editorial Board, Army Medical Department Center & School, ed. (2004). Emergency War Surgery (3rd ed.). Washington, DC: Borden Institute at Walter Reed Army Medical Center. Retrieved 2010-10-31.
• Solé, Felip; Camarasa, Josep Maria (February 2015). "Els pioners catalans de la medicina moderna" [Catalan pioneers of modern medicine]. Sàpiens (in Catalan) (Barcelona) 152: 34–39. ISSN 1695-2014.

External links

• Battlefield Medicine - The Ancient World 2000 BC-AD 500
• Digital Military Medicine Collections of the U.S. Army Academy of Health Sciences, Stimson Library
• Naval Special Warfare Command shifts from ATLS model to their own TCCC model as a result of new studies and the Iraq experience.
• The short film A METHOD OF TEACHING COMBAT SURGERY (1958) is available for free download at the Internet Archive