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PRE-HOSPITAL

The need to prevent hypothermia in trauma patients has been known in civilian trauma care but not nearly as diligently and routinely practiced as in military trauma care.

 

Throughout the history of medicine, modern trauma care has advanced greatly based on lessons learned in the military experience starting with the Korean War. Unfortunately, there is often a lag time between military lessons learned that have improved trauma care and translation and adoption of these practices into the civilian trauma system.

 

The historically high survival rates of combat casualties seen in the most recent long conflicts in Iraq and Afghanistan have garnered a great deal of attention in civilian practice. Concepts such as damage control resuscitation, hypothermia prevention, permissive hypotension, emphasis on blood products over crystalloids, the intraosseous vascular access, and the routine use of tourniquets are now practiced in civilian trauma care based on the recent military experience.

Emergency Medical Services – EMS

EMS across the US, as well as globally, is delivered in a variety of system models. If ever a saying applies to EMS systems, it would be the following; If you have seen one EMS system, you have seen one EMS system. This simply means that one size truly does not fit all. Dealing with geography; urban and rural; climatic regions and both public and private resources creates a unique mosaic of potentially optimal coverages and services to be managed.

Aeromedical Ambulance

Carrying and administering blood products in the field has been a very rare experience in civilian trauma systems. The past five years has seen significant and growing adoption of blood products safely given in the field, currently mostly by aeromedical EMS crews.

 

Since blood products are refrigerated, this has heightened the awareness of the need to maintain normothermic infusion temperatures to avoid accidental hypothermia related to infusion treatments. This trend is predicted to continue to grow, as there is no good substitute available or on the near horizon to resuscitation with actual blood products.

Ground Ambulance

EMS across the country is provided in many different forms. It is not unusual even within a city to have multiple EMS providers. Every state tends to divide EMS care within regions as far as oversight and techniques and procedures that are allowed within protocols under that regions agreed-upon medical direction. This historically was influenced by the practice patterns of the hospitals within the region.

 

There now are grounded ambulances which are carrying refrigerated blood products to accident scenes and administering blood products in the field. This is directly resulting from the military experience using the blood products in far forward casualty care in the Iraq and Afghanistan experiences. We are seeing the adoption of blood products on ground vehicles as more data and sharing of experiences of the early adopters gets into national conferences and literature.

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