Challenges of military nursing: come on board hospital ship COMFORT.
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Hospitals, Military↗
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Results for “Iraq War, 2003-2011”
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Combat orthopaedics: a view from the trenches.
Approximately 70% of war wounds involve the musculoskeletal system, and military orthopaedic surgeons have assumed a pivotal role in the frontline treatment of these injuries in Iraq. Providing battlefield orthopaedic care poses special challenges; not only are many wounds unlike those encountered in civilian practice, but patients also must be triaged and treated in an austere and dangerous environment, undergo staged resuscitation and definitive surgery, and endure prolonged medical evacuation, often involving ground, helicopter, and fixed-wing transport across continents. Most orthopaedic wounds in Iraq are caused by exploding ordnance--frequently, improvised explosive devices, or IEDs. Because of advances in care, rapid medical evacuation, and modern body armor, many casualties have survived in Iraq who would not have done so in previous wars. Treatment of war wounds, many of which are devastating in the scope of soft-tissue and bony injury, requires a team approach using hypotensive resuscitation, damage-control orthopaedics, new or rediscovered techniques of hemostatic and intravenous hemorrhage control, vacuum-assisted wound closure, and advanced reconstruction. Current challenges include prevention of infection, a better understanding of heterotopic ossification as a sequela of blast injury, and the need for a comprehensive, joint service database that encompasses the multilevel spectrum of orthopaedic care.
Humans↗
Missile injuries of the limbs: an Iraqi perspective.
Missiles include pistol or rifle bullets, shell fragments, land mines, and grenades. Medium- and high-velocity missiles produce damage by laceration and crushing, shock waves, and cavitational effects. Low-velocity missiles produce damage by laceration and crushing only. Land mine injuries cause damage by the primary blast effect, secondarily by fragments, and thirdly by the effect induced by whole-body propulsion and by burns. Severity of injuries should be graded according to the degree of soft-tissue damage, bone defect or comminution, and vascular or neural injury. Among other factors, successful management of these injuries requires prompt and vigorous resuscitation, careful wound inspection, aggressive exploration, liberal débridement, and prompt removal of fragments. In addition, in these circumstances, one must stay alert for overlooked injuries and be aware of associated psychological trauma.
Extremities↗
Standard wound coverage techniques for extremity war injury.
Reconstruction of extremity war injuries begins with aggressive forward resuscitative care and stabilization of the trauma patient. After serial care in progressively better supported medical environments, definitive management is done at the level V military treatment facility. Aggressive forward care coupled with rapid air transport has enabled increasingly complex care to be administered at the continental United States military facilities; however, it has also made the decision between limb salvage and amputation more challenging. Yet to be determined are (1) the optimal timing of definitive wound closure or coverage in coordination with fracture stabilization and (2) the optimal types of flap for both upper and lower extremity reconstruction. Records of patients with complex lower and upper extremity wounds who were treated at the National Naval Medical Center between September 2004 and June 2006 reveal useful short-term data. Longer-term data, such as fracture union rate, time to ambulation, range of motion and global function of salvaged limbs, patient satisfaction with limb salvage, and average cost, are not yet available.
Bandages↗
Scope of wounds.
The scope of extremity wounds in the current conflict presents surgeons with new lessons to master. Unique to this conflict is a new type of patient, one with multiple and severely injured extremities who is otherwise free of serious injury. These injuries provide challenges to the medical system in terms of the volume and complexity of care, and to the patient and surgeon trying to achieve limb salvage and rehabilitation. These patients present with a combination of high-energy injury, massive evolving tissue destruction, and widespread contamination, resulting in an evolving zone of injury that respects no tissue planes, anatomic boundaries, or normal physiologic rules. We must ensure that our skills and techniques as surgeons evolve faster than do the injuries themselves.
Extremities↗