Attrition: Critical Care Where It Counts The Most

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September 12, 2011: The U.S. Army is training 1,200 critical care medics, at a cost of $45,000 each, in order to staff medical evacuation (medevac) helicopters with more skilled personnel. This will save a lot of lives. It was quite by chance that the army discovered how this can make a big difference. It all came about because the army collects and analyzes a lot of statistics. One that someone came across was the fact that medevac medics belonging to National Guard (reserve) units had a 66 percent higher survival rate among the casualties they accompanied from the battlefield to the field hospitals. Taking a closer look, it was found this was because the National Guard medics tended to more highly trained, many of them being critical care emergency medical technicians in civilian life. This made the army realize that critical care trained medics on the medevac helicopters would make a difference. The first of these 1,200 new critical care medics will be ready for duty next year. That’s because the training for critical care medics is an additional eight months, in addition to the basic four months for new combat medics. The critical care medics can perform a lot more procedures and recognize a much longer list of problems. Thus existing, experienced medics, are being given the additional training.

This new army policy is actually part of a trend. Last year, Canadian forces added a medical technician to the crews of their medical evacuation helicopters, joining a trend that has played a part in saving the lives of many troops wounded in combat, or injured in a combat zone. Previously, Canadian troops had relied on American, or other NATO, air evacuation services. But now Canada had suitable helicopters (CH-146s) for that work, and established an air ambulance service. Following a four year old recommendation by their own military planners, Canada trained medical technicians to work on the medevac choppers, and thus increase the chances that badly wounded soldiers would survive. Canada has also upgraded all of its combat medical care during its years of operations in Afghanistan. This is part of a trend that has been going on since World War II. It's all about having more medical care available sooner.

The fighting in Iraq and Afghanistan has brought about a major change in how the United States deals with combat casualties. The result is that over 90 percent of the troops wounded, survive their wounds. That's the highest rate in history. There are several reasons for this. The main one is that medics, and the troops themselves, are being trained to deliver more complex and effective first aid more quickly. Military doctors now talk of the "platinum 10 minutes," meaning that if you can keep the wounded soldier, especially the ones who are hurt real bad, alive for ten minutes, their chances of survival go way up. Medics have been equipped and trained to perform procedures previously done only by physicians, while troops are trained to do some procedures previously handled only by medics. The critical care medics increase the number of special procedures available on the battlefield. This skill upgrade is made possible by a number of factors.

First, over the last few decades, there has been continuous development in methods and equipment for "emergency medicine" (ambulance crews and staff in emergency rooms.) This stuff had slowly been coming over to the military, but with the fighting in Iraq, it was soon adopted by most military medical personnel.

Second, there’s the high intelligence and skill level of the volunteer military. High enlistment standards have largely gone unnoticed by most people, but within the military, it's meant that combat troops, who are much brighter than at any time in the past, can handle more complex equipment and techniques. Getting the combat troops to learn these techniques is no problem, because for them, it could be a matter of life and death.

Third, medical teams, capable of performing complex surgery, are closer to the combat. These teams, like the medics and troops, have more powerful tools and techniques. This includes things like "telemedicine," where you do a videoconference with more expert doctors back in the U.S., to help save a patient.

The "platinum 10 minutes" is part of a century old trend. During World War II, the "golden hour" standard of getting wounded troops to an operating table, was developed. Antibiotics were also developed at about the same time, along with the helicopter (whose first combat mission, in 1944 Burma, was to recover injured troops). So these new developments are not anything exotic.

Finally, the military medical community has a track record of success that the troops know about. So everyone realizes that if they pitch in, chances of survival are good, and they are.

 


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