Implications of combat casualty care for mass casualty events.

Violence fromexplosivesand firearms results inmass casualty events inwhich the injured havemultiple penetrating and soft tissue injuries. Events such as those in Boston,Massachusetts;Newtown,Connecticut;andAurora, Colorado, as well as those in other locations, such as Europe and the Middle East, demonstrate that civilian trauma may at times resemble that seen in a combat setting. As the civilian sector prepares for and responds to thesecasualty scenarios, researchandtrauma practices that have emerged from the wars in Afghanistanand Iraqprovideavaluable foundation for responding to civilian mass casualty events. Several lessons learnedby theUSmilitarywere implementedduring the response to thebombings inBoston inApril of this year. Military researchhas foundthatapproximately25% of persons who die as a result of explosive or gunshot wounds have potentially survivablewounds.1 These individuals have injuries that are not immediately or necessarily lethal and have a chance to survive if appropriate care is rendered in a timely fashion. Themilitary has learned that implementation of evidence-based, clinical practice guidelines can reduce potentially preventable death.2 Certain aspects of these lessons also apply to multiple casualty scenarios in civilian settings. The care of wounded military service personnel is based on an integrated trauma system and involves timely point-of-injury intervention, coordinated patient transport, whole blood or blood componentbasedresuscitation,and initialoperating focusedoncontrol of hemorrhage and optimizing patient physiology. Referred toasdamagecontrol surgery, this approach involves abbreviated techniques insteadof longer definitive operations. The principles of combat casualty care should be considered in 3 phases: point of injury, during transport to the hospital, and hospital-based treatment. The wars have highlighted the importance of a trauma system to coordinate these phases and improve survival. In implementing this strategy, the military developed the Joint Trauma System, which is designedtoprovidewoundedtroopsanoptimalchance for survival and recovery.