Military medicine
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The rigid character of the skull provides protection for the brain; in trauma, however, concomitant brain swelling, contusion, and possible hematoma create increased intracranial pressure and likely further injury to brain and components. Rapid alleviation of such pressure reduces mortality and morbidity. ⋯ Such is not available at forward echelons of deployed military medical units. The author compares the austerity of forward-located neurosurgery against that farther to the rear and recommends the former on the merits of the major reduction of time between injury and surgery.
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U. S military medical personnel are currently trained to care for combat casualties using the principles taught in the Advanced Trauma Life Support (ATLS) course. The appropriateness of many of the measures taught in ATLS for the combat setting is unproven. ⋯ We will review some of the factors that must be considered in caring for wounded patients on the battlefield with an emphasis on the Special Operations environment. A basic management protocol is proposed that organizes combat casualty care into three phases and suggests appropriate measures for each phase. A scenario-based approach is needed to plan in more detail for casualties on specific Special Operations missions, and several sample scenarios are presented and discussed.