Battlefield medicine

Chronology of medical advances on the battlefield

• During Alexander the Great’s military campaigns in the fourth century BC, tourniquets were used to stanch the bleeding of wounded soldiers. Romans used them to control bleeding, especially during amputations. These tourniquets were narrow straps made of bronze, using only leather for comfort.
• An early stretcher, likely made of wicker over a frame, appears in a manuscript from c.1380. Simple stretchers were common with militaries right through the middle of the 20th century.
• During the Battle of Shrewsbury in 1403, Prince Henry had an arrow removed from his face using a specially designed surgical instrument.
• Ambulances or dedicated vehicles for the purpose of carrying injured persons. These were first used by Spanish soldiers during the Siege of Málaga., on the battlefield using a ligature for the artery of an amputated leg of a soldier.
• French military surgeon Ambroise Paré pioneered modern battlefield wound treatment. His two main contributions to battlefield medicine are the use of dressing to treat wounds and the use of ligature to stop bleeding during amputation.
• The practice of triage pioneered by Dominique Jean Larrey during the Napoleonic Wars. He also pioneered the use of ambulances in the midst of combat. Prior to this, military ambulances had waited for combat to cease before collecting the wounded by which time many casualties would have succumbed to their injuries.
• Russian surgeon Nikolay Ivanovich Pirogov was one of the first surgeons to use ether as an anaesthetic in 1847, as well as the very first surgeon to use anaesthesia in a field operation during the Crimean War.
• American Civil War surgeon Jonathan Letterman originated modern methods of medical organization within armies.
• In the late 19th century, the influence of notable medical practitioners like Friedrich von Esmarch and members of the Venerable Order of Saint John pushing for every adult man and woman to be taught the basics of first aid eventually led to institutionalised first-aid courses amongst the military and standard first-aid kits for every soldier.
• Advances in surgery - especially amputation, during the Napoleonic Wars and First World War on the battlefield of the Somme.
• Medical advances also provided kinder methods for treatment of battlefield injuries, such as antiseptic ointments, which replaced boiling oil for cauterizing amputations.
• During the Spanish Civil War there were two major advances. The first one was the invention of a practical method for transporting blood. Developed in Barcelona by Duran i Jordà, the technique mixed the blood of the donors with the same blood type and then, using Grífols glass tubes and a refrigerator truck, transported the blood to the frontline. A few weeks later Norman Bethune developed a similar service. The second advance was the invention of the mobile operating room by the Catalan Moisès Broggi, who worked for the International Brigades.

• The establishment of fully equipped and mobile field hospitals such as the Mobile Army Surgical Hospital was first practiced by the United States in World War II. It was succeeded in 2006 by the Combat Support Hospital.
• The use of helicopters as ambulances, or MEDEVACs was first practiced in Burma in 1944. The first MEDEVAC under fire was done in Manila in 1945 where over 70 troops were extracted in five helicopters, one and two at a time.
• The extension of emergency medicine to pre-hospital settings through the use of emergency medical technicians.
• The use of Remote physiological monitoring devices on soldiers to show vital signs and biomechanical data to the medic and MEDEVAC crew before and during trauma. This allows medicine and treatment to be administered as soon as possible in the field and during extraction. Similar telemetry units are used in manned spaceflight, where a flight surgeon at the Command Center can monitor vital signs. This can help to see issues before larger problems occur, such as elevated carbon dioxide levels, or a rise in body temperature indicating a possible infection.

  Current battlefield medicine used by the U.S military

Tactical Combat Casualty Care

1. Care Under Fire: Care rendered at the scene of the injury while both the medic and the casualty are under hostile fire. Available medical equipment is limited to that carried by each operator and the medic. This stage focuses on a quick assessment, and placing a tourniquet on any major bleed.
2. Tactical Field Care: Rendered once the casualty is no longer under hostile fire. Medical equipment is still limited to that carried into the field by mission personnel. Time prior to evacuation may range from a few minutes to many hours. Care here may include advanced airway treatment, IV therapy, etc. The treatment rendered varies depending on the skill level of the provider as well as the supplies available. This is when a corpsman/medic will make a triage and evacuation decision.
3. Tactical Evacuation Care : Rendered while the casualty is evacuated to a higher echelon of care. Any additional personnel and medical equipment pre-staged in these assets will be available during this phase.

Citations

Memoirs

• Robert "Doc Joe" Franklin. Medic!: How I Fought World War II with Morphine, Sulfa, and Iodine Swabs
• Allen N. Towne. Doctor Danger Forward: A World War II Memoir of a Combat Medical Aidman, First Infantry Division
• Littleton, Mark R. Doc: Heroic Stories of Medics, Corpsmen, and Surgeons in Combat popular American history