Time to Update Army Medical Doctrine

Knight, Ryan M; Moore, Charles; Silverman, Montane B

doi:10.1093/milmed/usaa059

Cited by 11 publications

(5 citation statements)

References 6 publications

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“…The use of a TSP is not considered appropriate for all conflict settings in particular where fighting is sporadic or frontlines are poorly defined. This is in contrast to the vision of the military medical community challenged by the nonlinear battlefields of Iraq, Afghanistan and the Arabian Peninsula, calling for a revision of the doctrine, training and the concept of the Role 1 care (tactical combat casualty care) [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Provision of trauma care in asymmetric warfare: a conceptual framework to support the decision to implement frontline care services

Salio

Pirisi²,

Bruni³

et al. 2022

Confl Health

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Introduction The emerging trends of asymmetric and urban warfare call for a revision of the needs and the way in which frontline trauma care is provided to affected population. However, there is no consensus on the process to decide when and how to provide such lifesaving interventions in form of Trauma Stabilization Point (TSP). Methods A three-step Delphi method was used to establish consensus. A focus group discussion was convened to propose a framework and develop the list of twenty-one (21) statements for validation of a group of experts. Results A panel of twenty-eight (28) experts reviewed the statements and participated to both first and second rounds. Comments and recommendations provided by the FGD and during round 1 were used to analyze the findings of the study. The proposed framework includes five main categories identified as interconnected components that facilitate the decision to implement or not the TSP. A total of sixteen (16) elements distributed across the five categories have been considered as being able to guide the decision to utilize such capability in high-risk security and resource constrained settings. Conclusion The TSP has the potential to prevent death and disability. The proposed framework and categories add a structure to the decision-making process and represents an important step to support emergency and trauma care planning and implementation efforts.

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Section: Discussionmentioning

confidence: 99%

Provision of trauma care in asymmetric warfare: a conceptual framework to support the decision to implement frontline care services

Salio

Pirisi²,

Bruni³

et al. 2022

Confl Health

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show abstract

“…Conventional military medical practice at the time of the Napoleonic Wars held that wounded on the battlefield should be left where they fell, and then gathered up at a single location following the conclusion of the battle [ 11 ]. At best, wounded soldiers had to rely on either self-evacuation or evacuation that relied on untrained and disorganized civilians [ 13 ]. Larrey observed that this often delayed care from 24 to 36 hours [ 11 ].…”

Section: Reviewmentioning

confidence: 99%

“…Men in the ambulance units wore standard uniforms, and carried a saber for personal defense [ 2 ]. These ambulances swiftly took the wounded, both friendly and enemy, from active battlefields, providing emergency services on the way, and gathered casualties at a chirurgicie de bataille [ 8 ] located 3 miles behind the lines [ 13 ], comparable to modern military field hospitals [ 2 ]. Ambulance units were effective and highly adaptable - in the Egyptian campaigns, Larrey adjusted the system to the sandy desert terrain.…”

Section: Reviewmentioning

confidence: 99%

“…The battlefield hospitals that the wounded were treated at were also stockpiled with large amounts of food, surgical supplies, and were sanitary, further innovations that Larrey developed [ 2 ]. Wounded soldiers in these hospitals received the most up-to-date care available at the time; surgeons employed Larrey’s innovative techniques of rapid amputation and thorough cleaning to significantly reduce gangrene and sepsis, dramatically improving patient survival [ 13 ].…”

Section: Reviewmentioning

confidence: 99%

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Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage System

Turner,

Shah

2024

Cureus

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Dominique-Jean Larrey was a prominent French surgeon who rose to fame during the age of the Napoleonic Wars. During his service in the French military, he developed dozens of medical innovations. Most important of all were his improvements to the evacuation of the wounded from the battlefield, triage of the wounded, and rapid surgical intervention. His innovations revolutionized military medicine and are still the basis for modern practice today.

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“…21 Properly equipping and training has been suggested as a new approach to enhancing the military medical system. 22 Recognizing differences in the delivery of trauma care in the military and civilian sectors, as well as some similarities in the management of trauma patients, it is fair to assume that the adoption of this approach could be extended to the civilian frontline medical system.…”

Section: Pre-eventmentioning

confidence: 99%

Applying the Haddon Matrix to Frontline Care Preparedness and Response in Asymmetric Warfare

Salio

Pirisi

Ciottone

et al. 2022

Prehosp. Disaster med.

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Introduction: Asymmetric warfare and the reaction to its threats have implications in the way far-forward medical assistance is provided in such settings. Investments in far-forward emergency resuscitation and stabilization can contribute to saving lives and increase the resilience of health systems. Thus, it is proposed to extend the use of the Haddon Matrix to determine a set of strategies to better understand and prioritize activities to prepare for and set-up frontline care in the form of Trauma Stabilization Points (TSPs). Methods: An expert consensus methodology was used to achieve the research aim. A small subject matter experts’ group was convened to create and validate the content of the Haddon Matrix. Results: The result of the expert group consultations presented an overview of TSP Preparedness and Operational Readiness activities within a Haddon Matrix framework. Main strategies to be adopted within the cycle from pre- to post-event had been identified and presented considering the identified opportunities in the context of the possibility of implementation. Of particular importance was the revision of a curriculum that fits the civilian medical system and facilitates its adaptation to the context and available resources. Conclusion: The new framework to enhance frontline care preparedness and response using the Haddon Matrix facilitated the identification of a set of strategies to support frontline health care workers in a more efficient manner. Since the existing approach and tools are insufficient for modern warfare, additional research is needed.

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Time to Update Army Medical Doctrine

Cited by 11 publications

References 6 publications

Provision of trauma care in asymmetric warfare: a conceptual framework to support the decision to implement frontline care services

Provision of trauma care in asymmetric warfare: a conceptual framework to support the decision to implement frontline care services

Dominique-Jean Larrey (1766-1842): The Founder of the Modern Triage System

Applying the Haddon Matrix to Frontline Care Preparedness and Response in Asymmetric Warfare

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