Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XVI: Wounds and Injuries of the Soft Tissues

Treatment Priorities

United States Department of Defense
Peer Review Status: Internally Peer Reviewed

Whereas all of the foregoing is felt to represent optimum management of war wounds, battlefields of the future may present medical officers with constraints beyond their control that preclude optimum casualty management. The lack of air superiority may deny aeromedical evacuation from forward areas. Tactical encirclement or weather may compel the forward maneuver element to hold its wounded. Battalion surgeons or physician assistants may find themselves in a position where they are denied the option of moving casualties to definitive care facilities.

Medical personnel or equipment shortfalls may be the limiting factor. A resource-workload mismatch may result from a casualty generation rate that overwhelms medical capabilities. In situations such as these, the battalion surgeon and the medical treatment facility chief surgeon must be prepared to limit treatment in consonance with their capabilities and certain treatment priorities.

1. The forward medical officer should observe the general principles of resuscitation to the extent possible. The inability to surgically control high-grade hemorrhage may necessitate the prolonged use of tourniquets.
2. The early institution of systemic antibiotics is of prime importance, especially when war wounds cannot be promptly treated surgically. Tetanus toxoid and morphine analgesia are given.
3. If any surgical and anesthetic capability exists, operative treatment of wounds is usually limited to local anesthesia and wound incision to improve drainage Under these circumstances, if wound incision is elected in the absence of blood transfusion capability, care should be exercised to avoid hemorrhage.
4. It is possible that even the larger definitive care facilities may find themselves overwhelmed by casualties or understaffed due to combat losses of their personnel. The area medical regulating officer may not be able to divert casualty excesses to other facilities. Under circumstances such as these, appropriate care may have to be limited to wound incision and antibiotics.
5. Simple non-occlusive dressings should be utilized. These dressings should allow, to the extent possible, egress of drainage from the wound.

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