What Makes Medical Care In This Environment Different?

1. What Makes Medical Care In This Environment Different? • Multi-Etiologic / Multi-System Injury Common • High Degree of wound contamination • Long delays between time of wounding and surgery common • Hostile care environment - Fire superiority is best medical care in a firefight • “Reverse Triage” - Treat least wounded first to maintain firepower

2. What Makes Medical Care In This Environment Different? • Weight and Bulk considerations for medical supplies / equipment • Only what can be carried on back is available • Multi-casualty situations common • Treatment is provided in echelons

3. Planning Factors In MOUT • Expect helicopter evacuation to be unavailable • Plan on long delays between wounding and surgery [>6 hr] unless surgery is done in the city • Plan on limited-to-no enroute medical care • Expect large numbers of casualties • Plan on casualties arriving with explosive munitions/weapons - On and in them • Plan for dealing with embedded munitions

4. Mogadishu Raid • Casualty Evacuation Issues • Helicopter evacuation impossible • Congested urban environment • High probability of being shot down • Ground extraction difficult/impossible • Congested urban environment ideal for ambushes and road-blocks. Navigation difficult. • High probability of being shot • Delayed evac leads to higher infection rate • Have medics administer antibiotic near point of wounding

5. Mogadishu Raid • Casualty Evacuation Issues • Loading of casualties • Critical casualties last on, first off • Inability to provide enroute care - medics not available, non-medical vehicles used, circumstances of combat • “Evacuation of Dead” - Not just a “Quartermaster Issue.” Use dead as “sandbags” around living wounded • Unloading casualties • Problems with rapid identification of most serious casualties