Significant Medical Advances on the Battlefield and the Changing Roles of Imaging

  • Les R. Folio


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.


Combat 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.


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Copyright information

© Springer New York 2010

Authors and Affiliations

  • Les R. Folio
    • 1
  1. 1.Associate Professor Radiology and Radiological Sciences Associate Professor Military and Emergency MedicineUniformed Services University of the Health SciencesBethesdaUSA

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