Posted on Dec 2, 2015
Why evacuating wounded troops by air might do more harm than good.
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This does not surprise me. I was a Huey door gunner and we did this almost daily in Vietnam. I'm not surprised. Not to mention the bouncing around of the Huey, the movement of the WIA was swift and sometimes physical with the patient. Loading and unloading was usually done by carrying the patient to the helicopter, and removing them was done quickly, but not without jerking the patient out and putting him on a flat board and running into the field hospital.
And now for the rest of the story:
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Over the last 15 years, the United States has flown its wounded troops out of combat zones to hospitals around the globe. The logic: get those hurt in places where medical supplies are limited to places where they are not. The fastest way to do this? By air.
Yet according to a new, first-of-its-kind study conducted by the University of Maryland School of Medicine, rapid air evacuation has the potential to cause more damage to those patients suffering from an extremely prevalent battlefield affliction–traumatic brain injury.
https://www.washingtonpost.com/news/checkpoint/wp/2015/11/30/study-air-evacuating-casualties-might-do-more-harm-than-good/
And now for the rest of the story:
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Over the last 15 years, the United States has flown its wounded troops out of combat zones to hospitals around the globe. The logic: get those hurt in places where medical supplies are limited to places where they are not. The fastest way to do this? By air.
Yet according to a new, first-of-its-kind study conducted by the University of Maryland School of Medicine, rapid air evacuation has the potential to cause more damage to those patients suffering from an extremely prevalent battlefield affliction–traumatic brain injury.
https://www.washingtonpost.com/news/checkpoint/wp/2015/11/30/study-air-evacuating-casualties-might-do-more-harm-than-good/
Injuries
Helicopters
Edited >1 y ago
Posted >1 y ago
Responses: 10
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So, I have read this article and here are my thoughts on it from a nursing perspective: 1. They are not talking about helicopter evac. They are talking about 9000-10,000ft elevation and pressurization for fixed wing aircraft going to altitude. This does not mean that there wont be pressure changes and it won't cause additional discomfort, but they were looking at specific elevation pressures (and for the most part, helicopters can't do them). 2. While this may be very valuable information, I pose the question.... what is the alternative?
We as a military are doing more with less. This includes people and equipment. We do not have large numbers of surface ships with medical staff that can transport these people by surface safely. There are not enough resources in theater to care for patients long term..... The best chance of success for MOST casualties is rapid evacuation from theater to Europe, then the leap back to the USA. While there are risks, it may be difficult to determine if someone should have greater risk of further TBI type issues or loss of life due to massive rest of the body trauma.... Personally, at this time, we should acknowledge the risk, but the system is the best it has been.....EVER.
We as a military are doing more with less. This includes people and equipment. We do not have large numbers of surface ships with medical staff that can transport these people by surface safely. There are not enough resources in theater to care for patients long term..... The best chance of success for MOST casualties is rapid evacuation from theater to Europe, then the leap back to the USA. While there are risks, it may be difficult to determine if someone should have greater risk of further TBI type issues or loss of life due to massive rest of the body trauma.... Personally, at this time, we should acknowledge the risk, but the system is the best it has been.....EVER.
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SGT (Join to see)
Maj Chris Nelson, I was wondering why cabin pressure was being talked about. Thank you for clearing up that.
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Maj Chris Nelson
SGT (Join to see) - With significant elevation changes, cabin pressure is adjusted for a couple reasons. Helicopters do not change pressure, they are a lower altitude flying aircraft so this article was not really referencing that (the human body can adjust/adapt to the pressures that they fly in without pressurizing the cabin). With elevation the air becomes thin.... less oxygen etc. That is why mountain climbers to the tallest peaks have issues with altitude sickness or have to bring external oxygen. With that being said, pressure changes also affect space. An example would be filling a balloon at ground level. Going up in the air, the pressure changes (even if not compensating for temperature changes) and the balloon will either expand or contract MORE/LESS depending on direction of travel (up or down). Eyes, Ears, Brain are more susceptible to these changes. The biggest reason is that they have little or no room to expand/contract with pressure changes.....blowing out ear drums, rupturing or increasing damage to eyes and retina, and with brain injury, you are applying extra pressure on the areas that are already compromised making it worse. Some issues arise with the addition or subtraction of pure oxygen.....too much oxygen can be just as bad as too little oxygen....and in some cases damage can be decreased by going to the other end (running less oxygen or more oxygen than normal depending on the situation).
So again, the question comes back to this: Do you increase the risk of TBI side effects to save the over all life from massive trauma? We have limits, and flying expedites care, but there is never anything done without some risk.
So again, the question comes back to this: Do you increase the risk of TBI side effects to save the over all life from massive trauma? We have limits, and flying expedites care, but there is never anything done without some risk.
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Maj Chris Nelson
Another thing to keep in mind is that Commercial aircraft pressurize to about 9000 ft cabin pressure (your ears pop going up and down, but you would feel the same at about 9000 ft on the side of a mountain). Military aircraft are leaky tubs designed for CARGO. They generally maintain 10,000 ft cabin pressure....a bit more uncomfortable than the commercial aircraft. Military aircraft CAN drive cabin pressure to lower altitudes for head trauma....say 3000 ft cabin pressure....but here is the trade off.... the aircraft can't fly as high in the endeavor to push cabin pressure down....and because of this the air is "thicker"....they use more fuel doing this (also fly slower due to air resistance), and due to lower elevation may have more turbulence. Trade offs MUST be had.....
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SGT (Join to see)
Maj Chris Nelson, Sir, thank you for this explanation. I can understand how the pressure would affect TBI. I'm thankful there has been a study to decrease TBI if possible. You can't pick and choose which casualties you put onboard. It's a toss of the dice which ones live or die, but the quicker the response time the more that will live.
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What would be the alternative though? Bumpy as it might be air medevac till beats ground casevac.
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CPT Ahmed Faried
MAJ (Join to see) - Sir, it talks about evacuation of wounded troops. Somewhere in the chain I assume they would have had to be Medevac'd first. But even if the larger focus is on longer flights from theater to treatment centers in Germany. The larger point still stands. Bumpy, issues with cabin pressure etc. But still no faster way to ensure wounded troops receive appropriate care.
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CPT Ahmed Faried
1stLt Nick S - true, i think in their example they were talking about fixed wing platforms. Modifed C-130s that serve as flying hospitals to transport wounded troops to Langstchul(sp?)
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MSG Todd Black
In Afghanistan, the Marines relied on the Brit's Merlin helicopters for MEDEVAC. I was told they fly so smoothly you could put a coup of coffed on the deck during flight and it would never spill. That was one downfall of the USMC's MTOE: no organic unit helicopter support of any significance.
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This could be very well true, but how else will evacuate a casualty quickly? The air is the fastest way to evacuate so what would be an alternate if not this way?
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SGT (Join to see)
SSG Audwin Scott, Oh, I know that! When we were pulling the wounded out we were going as fast as we could to get them onboard and get out of there.
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SSG Audwin Scott
GySgt John Olson - thanks for showing me another angle to this conversation. Good point!
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MAJ (Join to see)
GySgt John Olson -
Read the comments on the article page itself. There were some pretty intelligent refutations of the article's arguments.
Read the comments on the article page itself. There were some pretty intelligent refutations of the article's arguments.
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MAJ (Join to see)
GySgt John Olson
I agree. They were addressing the actual conditions the study was claiming to replicate.
I agree. They were addressing the actual conditions the study was claiming to replicate.
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