J Trauma
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Comparative Study
Combat urologic trauma in US military overseas contingency operations.
This article reports on the occurrences and patterns of genitourinary (GU) trauma in the contemporary high-intensity conflict of the overseas contingency operations (OCOs). ⋯ This is the largest report of GU injuries during any military conflict. The distribution and percentage of casualties with GU injuries in the OCO are similar to those of previous conflicts. Consideration should be given to personnel protective equipment for the areas associated with GU injuries and predeployment training directed at the care of these injuries.
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Comparative Study
Utilizing a trauma systems approach to benchmark and improve combat casualty care.
Derived from the necessity to improve the outcomes of soldiers injured on the battlefield, the U.S. military forces developed and implemented the Joint Theater Trauma System (JTTS) and the Joint Theater Trauma Registry based on U.S. civilian trauma system models. The purpose of this analysis was to develop battlefield injury outcome benchmark metrics and to evaluate the impact of JTTS-driven performance improvement interventions. ⋯ Despite the numerous challenges of a global trauma system, the JTTS has set the standard for trauma care on the modern battlefield utilizing evidence-based medicine. The development of injury care benchmarks enhanced the evolution of the combat casualty care performance improvement process within the trauma system.
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Comparative Study
Maximizing oxygen delivery during mechanical ventilation with a portable oxygen concentrator.
Transportation of the critically ill or injured war fighter requires the coordinated care and judicious use of resources. Availability of oxygen (O2) supplies for the mechanically ventilated patient is crucial. Size and weight of cylinders makes transport difficult and presents an increased risk of fire. A proposed solution is to use a portable oxygen concentrator (POC) for mechanical ventilation. We tested the SeQual Eclipse II POC paired with the Impact 754 and Pulmonetics LTV-1200 ventilators in the laboratory and evaluated the fraction of inspired oxygen (FIO2) across a range of minute volumes. ⋯ Oxygen is a finite resource, which is cumbersome to transport and may present a fire hazard. The relatively high FIO2 delivered by the POC makes this method of O2 delivery a viable alternative to O2 cylinders. However, patients requiring an FIO2 of 1.0 would require additional compressed oxygen. This system allows O2 delivery up to 76% solely using electricity. An integrated ventilator or POC capable of automatically compensating VT for POC output is desirable. Further patient testing needs to be done to validate these laboratory findings.
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Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome. ⋯ The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.