Journal of the Royal Army Medical Corps
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Fluid administration for trauma in the pre-hospital environment is a challenging and controversial area. There is not yet any equivocal answer which can be supported by clear unanswerable evidence. ⋯ As future evidence brings clarity to this area, these guidelines can be modified, and further consensus statements will be issued taking into account such information. When treating trauma victims in the pre-hospital arena: Cannulation should take place en route where possible Only two attempts at cannulation should be made Transfer should not be delayed by attempts to obtain intravenous access Entrapped patients require cannulation at the scene Normal saline is recommended as a suitable fluid for administration to trauma patients Boluses of 250 ml fluid may be titrated against the presence or absence of a radial pulse (caveats; penetrating torso injury, head injury, infants).
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Realistic training of health personnel for the resuscitation of military casualties is problematic. There are few opportunities for personnel to obtain the necessary experience unless working in a busy emergency or trauma environment. ⋯ This paper discusses the use of advanced simulation technology in the training of military resuscitation teams. Such training has been available to members of the Australian Defence Force (ADF) for two years.
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The initial management of burns, in common with all trauma, follows the ABCDE approach. The outline management plan detailed above assumes the availability of certain medical supplies but even simple measures are invaluable in burn care if they are all that are available. The most basic supplies required to resuscitate a casualty are oral salt and water in appropriate volumes. Similarly it should be possible in field conditions to monitor vital signs and urine output, dress the burns with clingfilm or plastic bags and wrap the casualty in absorbent materials.