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