Combat Casualty Care and Out-of-Hospital Care Providers
Role of Ultrasonography in Combat Casualty Care and Out-of-Hospital Care
In the hands of trained military health system (MHS) practitioners, hand-carried ultrasound (HCUS) technology has proven to be a durable and reliable method of rapidly assessing critically ill patients within MHS facilities in the continental United States and during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). It is used domestically by MHS careproviders and by Forward Surgical Teams, Shock Trauma Platoons, expeditionary medical facilities, and within Combat Support Hospitals in OEF and OIF. (Blood, Brooks, Madill, Stamilio) Brooks et al. documented the utility of Focused Assessment with Sonography in Trauma (FAST) by non-radiologists in a combat casualty care setting. (Brooks) It has also been reported as a method of avoiding unnecessary invasive procedures, such as needle decompression for presumed tension pneumothorax in out-of-hospital settings. (Do, Madill)
In addition, the military is progressively called upon to intervene in a variety of host-nation civilian care and humanitarian missions (e.g., post-earthquakes and tsunamis). Ultrasound is a well-documented method of improving field triage and initial assessment of patients in such out-of-hospital settings. (Beck-Razi, Dan, Dean, Huffer, Lyons, Raja, Miletic, Sarkisian, Sztajnkrycer). In view of the known utility and efficiency of HCUS in MHS clinical settings there exists the system-wide challenge of providing the requisite ultrasound training to the MHS cadre in a highly effective, uniform, and cost-effective manner.
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