Significant Medical Advances on the Battlefield and the Changing Roles of Imaging
- 687 Downloads
American and coalition forces can claim one overwhelming victory in recent conflicts: the highest survival rate of combat casualties in history. Approximately 98% of all casualties brought to our facility survived, a higher percentage than ever before in prior wars. Some of the most obvious contributions to these record survival rates are due to advances such as the Combat Application Tourniquet (CAT) and its clear indications from TCCC (Tactical Combat Casualty Care). Other major contributors to heroic survival success is clearly due to improved helicopter casualty and medical evacuation from the front lines to the many combat hospitals. In addition, Air Force air evacuation out of war zone to the upper echelons of care is described earlier in this book. Myself and others believe advanced imaging techniques and applications, some discussed here, have also significantly contributed to these record survival rates.
KeywordsCombat application tourniquet Tactical combat casualty care Casualty evacuation Medical evacuation Air evacuation Extended focused abdominal sonography in trauma Anatomic positioning system Trajectory analysis Decision support tools Health vault Universal trauma window
I would like to thank the following individuals for making this chapter possible. Dr. Rolf Bunger, for mentoring me on the trajectory analysis and APS concept. He encouraged me to further develop this work as he saw the potential clinical and public health impact. It was his idea to establish a reference point, whether it be the one that prevails over time or not, get that point and show that we can localize consistently. I would also like to thank Tatjana Fischer from the Technical University of Munich, Germany for choosing me as her mentor for her Ph.D. in APS and ballistic trajectory analysis. We succeeded in validating APS and that trajectories can be determined and calculated in actual combat casualties. To Lt Chris Backus USU class of 2010 for his piloting background and stimulating completion of the complex plane descriptions when he was a second year medical student. Also thanks to Sofia Echelmeyer for her excellent illustrations. To Gerd Frankfurter for brainstorming with me on the field ballistic study design. To Bill Knepshield, CEO of Operative Experiences, Inc. for donating the anatomic leg simulators. To Michael Frew, MD, and David Cruea for the sniping expertise and range. I would also like to thank Israel Felix, RT, and David Stancil; RT for working with us on getting high quality CTs of the legs and blast belly phantom. Thanks also to Dr. Andy Dwyer for helping with the Cartesian and trajectory calculator. Anna Grefe for her consultation in right triangles and 3D coordinates. Photos by Dominik Usling.
- 5.Gel’fand IM, Glagoleva EG, Kirllov AA. The method of coordinates. p.52. Available at: http://books.google.com/books?id=InstSVAf5wC&pg=PA56&lpg=PA56&dq=three-dimensional+plane+x+y+z&source=web&ots=625PBbcCGw&sig=pzyf1SxTKb4m4CbXqZkMPtcot-k&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA52,M1 (Accessed on Jan 2009).
- 7.Shogan P, Fischer T, Bunger R, Frew M, Provenzale J, Folio L. Anatomic positioning system applied to trajectory analysis. American Roentgen Ray Society. April 2010.Google Scholar
- 8.Fischer T, Shogan P, Bunger R, Frew M, Provenzale J, Folio L. Anatomic positioning system applied to trajectory analysis in combat casualties. European Society of Radiologists; Vienna, Austria. May 2010.Google Scholar
- 11.Folio L, Fischer T. Backus C. Determining trajectories of ricocheting blast and ballistic fragments from complex wound paths. Mil Med. Pending date.Google Scholar
- 12.Willson T, Folio L. Severe epistaxis from an intracranial vascular bleed from grenade injury. Mil Med. 2008 Sept; 173(9):v–vi.Google Scholar
- 13.Fischer T, Folio L. Abdominal blast injury resulting in liver laceration, diaphragm disruption, hemothorax. Mil Med. Pending date.Google Scholar
- 19.Fischer T, Folio L. Abdominal blast injury resulting in liver laceration, diaphragmdisruption, hemothorax. Mil Med. 2011 Sept; 176(09)Google Scholar
- 20.Fischer T, Folio L. Abdominal blast injury resulting in liver laceration, diaphragm disruption, hemothorax. Mil Med. 2011 Sept; 176(09)Google Scholar
- 21.Fischer T, Folio L. Ricocheting blast injury fragment. Mil Med. 2011 Aug; 176(08):Google Scholar
- 22.Andrews C, Andrews K, Folio L. Venous fragment embolism to the pulmonary artery: a rare occurrence — case report and literature review of venous fragment embolization to the pulmonary artery. Mil Med. 2009 Sept; 174(9):iv,v.Google Scholar
- 24.Folio L, Robinson D. Apical hemothorax from gunshot wound producing a pleural cap. Mil Med. 2009 Dec; 174(12):vii–viii.Google Scholar
- 25.Folio L, Fischer T. Anatomic Positioning System: Blast and ballistic trajectory analysis using Multi-Detector Computerized Tomography (MD CT). American Society of Emergency Radiologists Annual Convention; Orlando, FL. 1 2009 Oct.Google Scholar
- 27.Folio LR, Sears S, Lacy T. Teleradiology roundtable. Mil Med Technol. July 2007; 11(4): 6–11.Google Scholar
- 28.Folio L. Air force Telehealth Experience in Iraq. Diagnostic Imaging. 2005 Aug.Google Scholar
- 29.Folio L. Pak S. Patent Pending Serial Number: 11/447,516: G CROSS-SECTIONAL DIGITAL IMAGING INTO MOVIE FILE FORMAT. Filed in Patent and Trademark Office: 2006 June.Google Scholar
- 30.Folio L. Whitworth S. Universal Trauma Window Application in Damage Control Radiology. Exhibit/presentation at American Society of Emergency Radiology. 2009 Oct.Google Scholar
- 31.Shogan P, Folio L. A Standard, Secure and Universally Compatible Electronic Health Record for All Military, All Americans and Possibly All Nations by 2010. RSNA Exhibit. 2009.Google Scholar
- 32.Lodox Systems, North America, LLC. Available at: http://www.lodox.com (Accessed on Nov 24 2006).
- 33.Mirvis S. Use of total body digital radiography (Statscan) for acute trauma imaging: preliminary experience in comparison with traditional computed tomography. Available at: http://rsna2005.rsna.org/rsna2005/V2005/conference/event_display.cfm?em_id=441427611