AACN advanced critical care
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Review
Advancing critical care: joint combat casualty research team and joint theater trauma system.
Despite the severity and complexity of injuries, survival rates among combat casualties are equal to or better than those from civilian trauma. This article summarizes the evidence regarding innovations from the battlefield that contribute to these extraordinary survival rates, including preventing hemorrhage with the use of tourniquets and hemostatic dressings, damage control resuscitation, and the rapid evacuation of casualties via MEDEVAC and the US Air Force Critical Care Air Transport Teams. ⋯ Innovations being studied to decrease sequelae associated with complex orthopedic and extremity trauma are also presented. The role and contributions of the Joint Combat Casualty Research Team and the Joint Theater Trauma System are also discussed.
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Changes in reimbursement policies have focused attention on the use of indwelling catheters in the critical care unit as well as their role in hospital-acquired urinary tract infections. Implementation of an evidence-based prevention program can significantly reduce both the prevalence of indwelling catheterization and the incidence of hospital-acquired catheter-associated urinary tract infection. This article describes the epidemiology and pathophysiology of catheter-associated urinary tract infection, and outlines essential elements of an evidence-based prevention program for the critical care unit.
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In current military operations, the survival rates of critically injured casualties are unprecedented. An often hidden aspect of casualty care is safe transport from the point of injury to a field hospital and subsequently on to higher levels of care. This en route critical care, which is provided by flight medics under the most austere and rigorous conditions, is a crucial link in the care continuum. ⋯ This article provides an assessment of the operational issues, medical capabilities, and transport experiences to provide a real-world view of critical care transport from the battlefield. The MEDEVAC helicopter environment is one of the most difficult, if not the most demanding, critical care environments. This overview brings to light a small but important piece of the care continuum.