Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIII: Maxillofacial Wounds and Injuries

Evacuation

United States Department of Defense
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As previously discussed, the immediate priorities in. the management of the maxillofacial casualty are airway, hemorrhage, and circulating fluid volume. Once the patient has arrived at the primary treatment facility and early definitive surgical repair of the injury has been accomplished, the considerations for movement of the maxillofacial casualty consist of the following:

1. The patient should be afebrile, without evidence of active infection, comfortable, and taking adequate nourishment by mouth.
2. If intermaxillary fixation is in place and there is not sufficient space (i.e., missing teeth) to permit autoevacuation of regurgitated gastric contents, a means of rapid removal of the fixation must be provided. At the minimum, the patient must wear scissors or wire cutters around the neck.
3. Antral and nasal packings and other drains, along with date of placement, must be clearly identified.
4. Indwelling IV catheters should be of a flexible polyethylene type, well secured, and labeled with the size and date of placement.
5. Tracheostomy tubes and cannulas:
   1. must be of proper size, and
   2. must be well secured in place with the faceplate of the outer tube sutured to skin.
   3. Instructions for humidification must be clearly written. Aircraft have notoriously low cabin humidity, and this and other instructions concerning tracheostomy care are critical.
6. If it becomes necessary to evacuate a patient who has required nasogastric suction at ground level, it will certainly have to continue to be observed during flight.
7. Cerebrospinal fluid leaks, not uncommon in maxillofacial war wounds, do not contraindicate evacuation, but increases in such drainages may occur at altitudes and it must not be impeded.
8. Clear, concise, legible orders must accompany the patient with special attention to:
   1. IV fluids
   2. antibiotics
   3. analgesics
   4. antiemetics
   5. remaining packings, cannulae, drains, and tubes
   6. diet

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