Medicine on the battlefield: a review.

Management of combat injuries The climax in military medical activity is the management of battle casualties. This comprises a continuous chain of activities which starts with the first aid given by other servicemen, and continues with the measures taken by the medical corpsman, the battalion (regimental) first aid station, the medical company ('field ambulance'), etc. The sequence of first aid, resuscitation and surgery is intended to preserve life and vital functions until the patient arrives at the hospital, where definite surgical treatment is available. When helicopters are available, the process of medical evacuation to hospital is shortened; however, air-evacuation may not be possible in certain battlefield conditions. Evacuation of battle casualties is a complex operation and should be performed under medical supervision to ensure that appropriate care is given. The military physician operating under such conditions must be acquainted not only with the medical aspects of his job, but also with the military situation around him. In the 1973 ArabIsraeli war, physicians were cut off from their units and continued to take care of their patients and their survival for many hours until contact was reestablished. The medical principles and objectives remain traditional: haemostasis, respiration, resuscitation, treatment of shock, immobilization of fractured bones, stabilization of the patient, prevention ofwound infection and quick evacuation to hospital. On the other hand, the medical problems facing the physician change: there have been new types of injuries, more cases of 'multiple injuries' due to fragments, and more tissue destruction. The following observations from 1973 apply in the field. Little will be said about treatment in hospital, which usually is described in relation to the appropriate specialty.