Conceptual principles of the wounded combatants’ evacuation, suffering military surgical trauma on the medical support levels

Keywords: combat surgical trauma; medical evacuation; estimation of trauma severity; levels of medical support; traumatic shock.

Abstract

Objective. To improve the results of treatment of the wounded persons, suffering a combat surgical trauma, elaborating and introducing of objective scales of the trauma severity estimation into the medical evacuation system while conduction of Antiterroristic operation / Operation of Joint Forces.

Materials and metods. Complex medical-statistical investigation was performed, in which 684 wounded persons, suffering a combat surgical trauma were included. Dynamical medical control and determination of the trauma severity degree in accordance to AdTS (Admission trauma Scale) were applied on all levels of medical support.

Results. In the beginning of conduction of Antiterroristic operation / Operation of Joint Forces a mortallty have had occurred during transportation of wounded persons in unstable state (more than 9 points) to military-medical clinical centers. The wounded persons in a traumatic shock state were transported on forth level of medical support, what have been considered an organization defect in the help deliver process, which leaded to death of military persons. At the same time an unjustified delay of transportation of servicemen, suffering wounds of the wrist and foot (up to 5 points), on the first and second levels of medical support, leading to development of severe complications, have occurred. Taking into account the above mentioned, the authors have provided a differentiated approach for medical evacuation of wounded persons, suffering a combat surgical trauma, depending on its severity degree.

Conclusion. Evacuation of wounded persons, suffering a combat surgical trauma, constitutes an integral part of the medical support system of Antiterroristic operation/Operation of Joint Forces, closely connected with a medical support process during transportation. Medical evacuation of wounded persons with injuries of the vision organ, the wrist and foot must be accomplished urgently to specialized clinic of the fourth level of medical support.

Author Biographies

I. P. Khomenko, The Medical Forces Headquarters in Military Forces of Ukraine, Kyiv

Khomenko Igor Petrovich, MD, DSci(Med), Professor
Command
Medical Forces of the Armed Forces of Ukraine, Kyiv,
03168, Kyiv, 6, Povitroflotsky ave.
+380503580279.
hip65@ukr.net
orcid.org/0000-0002-8199-5083

I. A. Lurin, Ukrainian Military-Medical Academy, Kyiv

Lurin Igor Anatolievich, MD, DSci(Med), Professor
Professor of the Department of Military Surgery
Ukrainian Military Medical Academy, Kyiv,
01015, Kyiv, 45/1, Moskovskaya str., h. 33.
+380501353039.
lurin@i.ua
orcid.org/0000-0001-6280-1725

S. O. Korol, Ukrainian Military-Medical Academy, Kyiv

Korol Serhii Olexandrovich, MD, DSci(Med), Professor
Professor of the Department of Military Surgery
Ukrainian Military Medical Academy, Kyiv,
01015, Kyiv, 45/1, Moskovskaya str., h. 33.
+380976909858.
sergej.korol72@gmail.com
orcid.org/0000-0002-1036-0355

V. Yu. Shapovalov, Military-Medical Centre of Southern Region, Odessa

Shapovalov Vitalii Yuriovich, MD, PhD(Med),
a leading surgeon
Military Medical Clinical Center of the Southern Region, Odesa,
65044, Odesa, 2, Pirogovska str.
+380508155113.
vushapo@gmail.com
orcid.org/0000-0002-4241-0775

B. V. Matviichuk, Military-Medical Treatment-Rehabilitation Centre, Irpin

Matviichuk Bohdan Vladislavovich, MD,
Resident of traumatology department
Military medical and rehabilitation center, Irpin.
08200, Irpin, 11th line str., h. 1.
+380632154423.
matviichuk@i.ua
orcid.org/0000-0003-3770-3984

References

Butler WP, Steinkraus LW, Fouts BL, Serres JL. A Retrospective Cohort Analysis of Battle Injury Versus Disease, Non-Battle Injury-Two Validating Flight Surgeons' Experience. Mil Med. 2017;182(1):155-61. doi: 10.7205/MILMED-D-16-00166.

Khomenko IP, Korol SO, Matviychuk BV, Ustinova LA. Pathophysiological substantiation of medical evacuation of the wounded persons, suffering injuries of the extremities on the levels of medical support. Klin Khir. 2019;86(6):25-9. doi: 10.26779 / 2522-1396.2019.06.25.[In Ukrainian].

Kotwal RS, Staudt AM, Trevino JD, Valdez-Delgado KK, Le TD, Gurney JM, et al. A Review of Casualties Transported to Role 2 Medical Treatment Facilities in Afghanistan. Mil Med. 2018;183(1):134-45. doi: 10.1093/milmed/usx211.

Maddry JK, Arana AA, Perez CA, Medellin KL, Paciocco JA, Mora AG, et al. Influence of Time to Transport to a Higher Level Facility on the Clinical Outcomes of US Combat Casualties with TBI: A Multicenter 7-Year Study. Mil Med. 2020;185(1-2):138-45. doi: 10.1093/milmed/usz178.

Maddry JK, Ball EM, Cox DB, Flarity KM, Bebarta VS. En Route Resuscitation - Utilization of CCATT to Transport and Stabilize Critically Injured and Unstable Casualties. Mil Med. 2019;184(5-6):172-6. doi: 10.1093/milmed/usy371.

Robert J, Tourtier JP, Vitalis V, Coste S, Gaspard W, Bourrilhon C. Air Medical-Evacuated Battle Injuries: French Army 2001 to 2014 in Afghanistan. Air Med J. 2017;36(6):327-31. doi: 10.1016/j.amj.2017.08.001.

Shackelford SA, Del Junco DJ, Powell-Dunford N, Mazuchowski EL, Howard JT, Kotwal RS, et al. Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival. JAMA. 2017;318(16):1581-91. doi: 10.1001/jama.2017.15097.

Staudt AM, Savell SC, Biever KA, Trevino JD, Valdez-Delgado KK, Suresh M, et al. En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan. Crit Care Nurse. 2018;38(2):7-15. doi: 10.4037/ccn2018532.

Travers S, Carfantan C, Luft A, Aigle L, Pasquier P, Martinaud C, et al. Five years of prolonged field care: prehospital challenges during recent French military operations. Transfusion. 2019;59(2):1459-66. doi: 10.1111/trf.15262.

Ziemba R. Analysis of the causes of medical evacuation of injured and sick soldiers of the Polish Military Contingent in the Islamic State of Afghanistan taking part in International Security Assistance Force operations. Med Sci Monit. 2012;18(4):22-8. doi: 10.12659/msm.882604.

Zarutskiy YaL, Korol SO, Kreshun EA. Differential management of rendering traumatologic care to wounded From combat limb injuries during medical evacuation. Odessa Medical Journal.2017;(3):18-23. [In Ukrainian].

STANAG 2546 - AJMedP-2 - Allied Joint Doctrine For Medical Evacuation. 24 November 2008. 3 p.

Published
2020-07-24
How to Cite
Khomenko, I. P., Lurin, I. A., Korol, S. O., Shapovalov, V. Y., & Matviichuk, B. V. (2020). Conceptual principles of the wounded combatants’ evacuation, suffering military surgical trauma on the medical support levels . Klinicheskaia Khirurgiia, 87(5-6), 60-64. https://doi.org/10.26779/2522-1396.2020.5-6.60
Section
General Problems of Surgery