In medical school, students are trained to practice medicine in a relatively controlled environment. The medications and technology required for proper patient care are usually available, and there are many other physicians nearby if assistance is required. This is essentially the opposite of providing medical care in an area of active combat. The medical crews involved in the army practice in an extremely volatile and unpredictable environment. Injuries are often complicated and multi-faceted, and the surrounding environment is not safe. Awareness of surroundings becomes a necessity, not only to ensure patient safety but also to ensure the safety of the medical crew.
If the injured individual is a civilian, extra precautions must be taken. For the safety of the helicopter and all of the personnel onboard, the soon to be patient must be checked for explosive devices. Emergency departments in the United States do not have suicide bombers at the top of their concerns, but in current combat zones it is a very real concern. Members of the crew must also sweep the area for potential hostiles, creating a very tense atmosphere in which the patient must be identified and transported to a vehicle, such as a helicopter.
The injuries that the individual may have sustained in the combat zone likely also had multiple injury mechanisms. Explosives alone may cause blunt, penetrating, crush, blast, or burn injuries. It is not simply the explosive itself but also where the patient was thrown by the explosion and what debris were thrown onto the patient. The most serious injuries may not be the most visible. Additionally, IVs are often placed on the move. Medical students learn how to place IVs on very steady, immobile patients. Placing a good IV in a moving helicopter is a whole different ordeal.
To make matters more complicated, the first facilities that medical crews can take patients are not equipped with advanced imaging technology. They usually have ultrasound and x-ray machines, but lack MRI and CT scans. It can be extremely difficult to analyze a complicated injury such as that of an explosive device without advanced imaging. While other, larger medical facilities in the area will have advanced imaging, there is always the factor of time to consider.
The larger facilities also become targets so they must be resilient against explosives. They are, however, relatively safe and provide a higher level of medical care. In extreme injuries, military personnel may be transported back to American soil for further treatment after stabilization. The general approach to injuries is to evaluate airway, breathing, circulation, c-spine injury, disability, and environment. In a combat zone, the priority is almost always to stop bleeding and the environment is a constant threat. Even with all of the dangers and additional factors to consider, mortality rates during war have been decreasing due to technological advances and improved training. Ideally this trend will continue, and we will also find better means of caring for veterans when they return home.