Operating theatre at war: 30 minutes per patient, then the next one
- Battlefield medicine differs from civilian medicine in terms of the operating environment, available resources, and the need to respond quickly in high-threat situations.
- Sometimes, military procedures are adapted to civilian conditions, which allows for effective action in crisis situations, such as attacks or shootings.
- One example is Damage Control Surgery.
- It focuses on rapid surgical intervention, eliminating immediate life-threatening situations before the patient is fully medically cared for.
- The surgical team usually has about 30 minutes for such a quick intervention.
- Such quick preparation of the patient for further treatment is crucial, especially in the case of mass casualty incidents, where the number of injured exceeds the capacity of a single facility.
The war in Ukraine has reignited the debate about whether we are prepared to act in the event of armed conflict. One element of resilience is adequate medical care, both military and civilian.
First, we explain how battlefield medicine differs from civilian medicine.
The differences between military and civilian medicine can be described in three key ways. The first is the operating environment for medical personnel, which is extremely dangerous, unfavorable, and unpredictable.
"The second thing is the forces and resources we have on site, without support from the rear. Because these forces and resources are usually very limited, we have to manage them very well," explains Second Lieutenant Artur Skobel, a paramedic and former special forces operator, currently associated with the Combat Medicine and Medical Simulation Department of the Military Institute of Medicine.
The third distinguishing feature is the race against time, because the time it takes for the injured person to reach the hospital will be much longer than those that are available on a daily basis in the civilian system.
Battlefield medicine is also based on procedures designed for operations in armed conflict, which are sometimes adapted to events in civilian environments, for example during attacks, shootings, or other high-risk situations.
An example is the Tactical Emergency Casualty Care (TECC ) protocol, modeled after the military's Tactical Combat Casualty Care (TCCC ). This protocol is used in life-threatening situations resulting from the use of weapons and combat assets in civilian environments. Military resuscitation team management systems, such as the Trauma Team, have also been successfully implemented in civilian hospitals.
Another measure that transfers military experience to the civilian system is the Damage Control Surgery (DCS) protocol, which focuses on rapid surgical intervention, eliminating immediate life-threatening situations before the patient receives full medical care.
"First, the emergency team must quickly prioritize its actions, identify the immediate threat to life, and eliminate or limit it. For surgical teams, the goal is to dramatically reduce the patient's time in the operating room, to approximately 30 minutes," says Second Lieutenant Skobel.
This means, for example, tying off bleeding vessels, even without completely "locking" the patient up, but with appropriate aseptic care. Afterward, the patient is moved to another room to make room for the next patient.
Such rapid preparation of the patient for further treatment is crucial, especially in the case of mass casualty incidents, where the number of injured exceeds the capacity of a single facility, even with multiple operating theaters. This prevents bottlenecks.
The traditional approach of providing full care to one patient for many hours would cost the lives of many others.
The statements were recorded during the Battlefield Medicine panel during the XXXIII Economic Forum in Karpacz.
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