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Emergency War Surgery
Medical personnel of enemy forces are not considered
internees, but are classified as “retained” in order to treat
other EPWs. Internees are also entitled to the protections
afforded under the provisions of the Geneva Convention
Relative to the Treatment of Prisoners of War (GPW).
Detained persons who are not protected under GWS and
GPW, may be protected under the provisions of the Geneva
Convention Relative to the Protection of Civilian Persons in
Time of War (GC).
The GWS states that belligerents must care for the sick and
wounded without any adverse distinction founded on sex,
race, nationality, religion, political opinions, or any other
similar criteria. Only medical urgency can justify priority
in the order of treatment.
EPW/Retained/Detained Medical Care (Internees)
Workload
The number of internees and retained/detained personnel
requiring medical in-processing and/or medical care can be
staggering. The US captured approximately 425,000 prisoners
in WW II and 105,000 in the Korean conflict. Coalition forces
captured over 62,000 internees during Operation Desert Storm.
During the 1-week ground war, 308 internees were treated by
US military medical treatment facilities (MTFs). From the end
of the ground war (28 February 1991) until the end of March
1991, 8,979 internees were treated.
Fragment wounds accounted for 44% of the surgical
admissions during the ground war.
23% of surgical admissions required treatment for fractures.
Surgical intervention was required in 28% of Iraqi casualties
admitted.
Most common operative procedures included
ο Wound debridement.
ο Open reduction and internal fixation of fractures.
ο Exploratory laparotomies.
ο Incision and drainage of abscesses.
34.2
Care of Enemy Prisoners of War/Internees
The most common internee medical condition reported
during Operation Desert Storm was dental disease (24%) such
as periodontal infections, fractures, and extensive caries.
Other common medical illnesses were unexplained fever,
nephrolithiasis, peptic ulcer disease, and malaria.
Wounds in internees may be different than those seen in
friendly forces due to differences in personal protective
gear, preexisting diseases, malnutrition, and neglect.
Medical Care of Internees
What healthcare providers should do.
ο
No matter the setting, healthcare providers have a
responsibility to report information, the consequences of
which constitute a clear and imminent threat to the lives
and welfare of others. Information gained from patients
who are internees should be treated no differently.
ο
As given below, healthcare providers have specific
responsibilities for the care and treatment of internees. The
overarching principle of this guideline, however, is that
internees of any status should whenever possible receive
medical care equal to that of our own troops.
♦ As one would expect for our own troops, physicians
should report any suspected abuse or maltreatment of
a detainee or prisoner.
♦ Just as one would write a profile or duty limitation for
one of his own service members, physicians have a
responsibility to inform the detention facility chain of
command of internees’ activity limitations. This
includes “clearing the prisoner for interrogation,” with
the expectation that interrogation will conform to the
standards of AR 190-8. Medical recommendations
concerning internee activities are exactly that—
recommendations. Decisions concerning internee
activities are made by the chain of command.
ο
Healthcare providers should be trained in the tenets of the
Geneva Conventions of 1949 and other documents and
principles of internee care. They should also be trained to
34.3
Emergency War Surgery
recognize the symptoms and signs of internee
maltreatment or abuse.
What healthcare providers should not do.
ο Healthcare professionals charged with any form of
assistance with the interrogation process, to include
interpretation of medical records and information, should
not be involved in any aspect of internee healthcare.
ο Healthcare providers charged with the care of internees
should not engage in any activities that jeopardize their
protected status under the Geneva Conventions.
ο Healthcare providers charged with the care of internees
should not be actively involved in interrogation, advise
interrogators how to conduct interrogations, or interpret
individual medical records/medical data for the purposes
of interrogation or intelligence gathering.
Recusal. Healthcare providers who are asked to perform
duties they feel are unethical should ask to be recused.
Requests for recusal should first go to the healthcare
provider’s commander and chain of command. If the chain
of command is unable to resolve the situation, providers
should engage the technical chain by contacting the
Command Surgeon. If these avenues are unfruitful, healthcare
providers may contact their specialty consultants or the
Inspector General.
Specific medical requirements. Medical requirements for
internee care are provided in AR 190-8/OPNAVINST 3461.6/
AFJI 31-40/MCO 3461.1. Internees are entitled to medical
treatment. Each must have an examination on arrival at the
detention facility, as well as a chest radiograph (tuberculin
skin test for children up to age 14 years). Sick call must be
available daily, and each internee must be weighed at least
once a month. Sanitation and hygiene must be maintained at
all times (AR 190-8, para 3-4 i.).
Medical records.
o Internee medical records, like the medical records of all
Service members, retirees, and their dependents are
property of the US Government. Internees are entitled to
copies of their medical records upon their release. The
original records; however, remain the property of the
34.4
Care of Enemy Prisoners of War/Internees
United States. Entries should be made into internee
medical records as they would for any other patients.
ο
The Health Insurance Portability and Accountability Act
does not apply to the medical records of internees (DoD
6025 C5.1, C7.10, C7.11). However, the handling,
disposition, and release of all types of medical records is
governed by regulation. Commanders and other officials
who have an official need to know can access information
contained in internee medical records by following the
procedures given in AR 40-66, Chapter 2 using DA Form
4254. Patient consent is not required. Receiving MTFs file
and maintain all DA Form 4254s. The MTF commander or
commander’s designee, usually the patient administrator,
determines what information is appropriate for release.
Only that specific medical information or medical record
required to satisfy the terms of a legitimate request will be
authorized for disclosure. Healthcare providers should
expect that released medical information will be used by
the chain of command, to include interrogators, in
accordance with Medical Information, which follows.
Medical information.
ο
Because the chain of command is ultimately responsible
for the care and treatment of internees, the detention
facility chain of command requires some medical
information. For example, patients suspected of having
infectious diseases such as tuberculosis should be
separated from other internees. Guards and other
personnel who come into contact with such patients should
be informed about their health risks and how to mitigate
those risks.
ο
Releasable medical information on internees includes that
which is necessary to supervise the general state of health,
nutrition, and cleanliness of internees, and to detect
contagious diseases. Such information should be used to
provide healthcare; to ensure health and safety of internees,
soldiers, employees, or others at the facility; to ensure law
enforcement on the premises; and ensure the
administration and maintenance of the safety, security, and
good order of the facility. Under these provisions,
34.5
Emergency War Surgery
healthcare providers can confirm that an internee is healthy
enough to work or perform camp duties.
Reporting.
ο The chain of command is the first and foremost channel
for information and reporting. Healthcare providers
should report routine medical information, clear and
imminent threats, suspicions of abuse or maltreatment, and
any other relevant information to their commanders or
their commanders’ designees. If the healthcare provider
is not assigned to the detention facility, mechanisms must
be in place to also inform the detention facility chain of
command.
ο Alternative means of reporting exist for healthcare
providers who are unable to resolve issues through the
chain of command. The technical chain is the first
alternative, and begins with the Command Surgeon
responsible for medical oversight of the provider’s
activities. Other alternatives include the provider’s
specialty consultant, the Inspector General, and Criminal
Investigations.
Setup/Planning
Develop plans for prisoners on a hunger strike or who refuse
treatment.
Prisoners from separate armies should be housed apart—this
is the responsibility of the internment camp commander.
Care should be exercised in the selection of medical personnel
to serve in internee facilities.
Enemy forces may do little or no medical screening prior to
conscription. Chronic medical problems will be more likely
in these forces. Enemy forces may have preexisting diseases
that are not present in the AO or US forces. Planning for
appropriate medications may be required.
Maintain medical records for internees in the same manner
as for friendly forces.
Ensure that any internee/retained/detained person
evacuated to the MTF for treatment is escorted by an armed
guard as designated by the nonmedical (echelon) commander.
The guard must remain with the patient while in the medical
34.6
Care of Enemy Prisoners of War/Internees
evacuation and treatment chain. To the greatest extent
possible, keep all internees segregated from friendly forces’
patients; but treat all enemy patients with the same level
of care as provided to friendly forces’ patients.
An internee identification number must be secured for any
internee evacuated through medical channels. This is
accomplished by reporting the patient to the theater
Prisoner of War Information System (PWIS). Medical
personnel do not search, guard, or interrogate internees
while in medical channels; this is the responsibility of the
echelon commander.
Internees are housed in internment facilities that are
established, maintained, and guarded by forces designated
by the echelon commander. Medical personnel are not
involved in the daily operations of these facilities.
However, these facilities normally have a medical staff
embedded in the organization to accomplish medical
examinations and to conduct routine sick call and
preventive medicine activities. Control procedures (guards,
physical layout, and precautionary procedures) are regulated
by the facility commander. If a patient must be transferred to
an established MTF for specialized care, transfer procedures
and guards are governed by the facility commander.
In a mature theater (such as during WW II and the Gulf War
of 1991 [Desert Storm]), there are often sufficient internee
patients to warrant the designation of a specific hospital for
their exclusive care. In this case, coordination between the
senior command and control headquarters, and the senior
medical command and control headquarters is required to
provide security, establish prisoner-control procedures, and
regulate other nonmedical matters involved in establishing
and administering a medical facility specifically for internees.
The standard of care for this facility is required to be the same
standard of care as practiced in other deployed hospitals.
It is critical that medical personnel not enter the general
EPW holding area, but have patients brought out to them
for sick call and any medical treatment.
34.7
Emergency War Surgery
Interpreters—Always a Shortage
Internees may not know any other language but their own.
NATO STANAG 2131, Multinational Phrase Book for Use by
the NATO Medical Services - AMedP-5(B) provides basic
medical questions in a number of NATO languages,
published as DA Pam 40-3/NAVMED P-5104/AFP 160-28.
Use other retained persons/internees (especially medical
personnel) as translators.
Simulation of mental illness by EPWs is a potential technique
for evading interrogation, especially if combined with a
captured interpreter.
Screening
Ensure internees are screened for hidden weapons and other
potentially dangerous materials. This is not a medical
function; it should be accomplished by the guards. Medical
personnel, however, must remain vigilant of these threats
and mentally prepared should a threat or attack occur.
Each prisoner who comes into the facility must receive a
complete physical examination including a dental
examination. Vital statistics are recorded for each internee
treated. Essential care should be given at this point. Other
follow-up evaluations are dependent on the baseline health
of the combatant population.
During internment, routine sick call is provided on a daily
basis; this includes medication dispensing, wound care, and
indicated minor procedures.
During transfer, release, and/or repatriation, another medical
examination should be performed. Final documentation of
any ongoing medical, surgical, or wound care problem is
completed and forwarded to the gaining facility or to the
appropriate medical records repository.
Supply
The internment facility must enforce field hygiene and
sanitation principles.
Plan for personal hygiene requirements and protective
measures (insect netting, insect repellent, sunscreen).
34.8
Care of Enemy Prisoners of War/Internees
Coordinate with the supporting medical HQ for additional
Preventive Medicine support (pest management, potable
water, dining facility sanitation, and waste disposal) and
Veterinary Services support for food safety as required.
For medicolegal purposes, a high-quality camera is
important.
Medical Staffing
Dictated by the organizational structure of the facility. The
same standard of care as that provided to US forces must be
maintained.
Retained medical personnel should be utilized for care of their
compatriots in conformity with the Geneva Conventions.
Legal
If possible, signed permission should be obtained for all
surgical or invasive procedures.
In contrast to civilian medical photography, the patient’s
identity should be absolutely clear in each photograph.
This is invaluable should there be a claim of unnecessary
surgery or amputation. With clearly identifiable
photographs, the state of the wound for that patient can
be demonstrated.
Any patient who requires amputation or major
debridement of tissue should be photographed (face as well
as wound images).
Internee Advocate
The military physician is the commander’s advisor for
medical ethics. The physician should be alert for potential
and actual ethical conflicts, and exert all efforts to remedy
any perceived conflicts. As the patient’s advocate (in this
case, the captured enemy soldier), the military physician and
all military healthcare providers must maintain the patient’s
health. They must also strive to maintain a “moral distance”
from participating in any proceeding potentially adverse to
the patient’s interest.
34.9
Emergency War Surgery
Security
There is always an element of danger to the medical staff in
treating internees.
Physical security will be provided by nonmedical personnel
as designated by the appropriate leadership.
The security routine must be maintained at all times. Security
personnel must accompany all internees whenever they are
in a treatment area or holding area. In forward areas, it may
not be possible to have separate and secure medical
treatment/holding areas for internees. The limited size and
compact layout of Level I and II MTFs and the forward
surgical team normally necessitate that internees are treated
and held in close proximity. To the extent possible, internees
should be segregated from allied, coalition, and US forces.
If possible, medical equipment should not be taken into the
patient wards for security reasons—ie, bring the patient to
the equipment.
If an EPW is to be discharged back to the general EPW
population, the physician should alert internment medical
personnel of any special needs the internee may have.
Personal safety should never be taken for granted by the
medical team, regardless of familiarity with internees and
surroundings.
34.10
Appendix 1
Principles of Medical Ethics relevant to the
role of health personnel, particularly
physicians, in the protection of prisoners
and detainees against torture* and other
cruel, inhuman or degrading
treatment or punishment
Adopted by United Nations General
Assembly Resolution 37/194 of
18 December 1982
Principle 1
Health personnel, particularly physicians, charged with the
medical care of prisoners and detainees have a duty to
provide them with protection of their physical and mental
health and treatment of disease of the same quality and
standard as is afforded to those who are not imprisoned or
detained.
Principle 2
It is a gross contravention of medical ethics, as well as an
offence under applicable international instruments, for health
personnel, particularly physicians, to engage, actively or
passively, in acts which constitute participation in, complicity
in, incitement to or attempts to commit torture or other cruel,
inhuman or degrading treatment or punishment.
Principle 3
It is a contravention of medical ethics for health personnel,
particularly physicians, to be involved in any professional
A1.1
Emergency War Surgery
relationship with prisoners or detainees the purpose of which
is not solely to evaluate, protect or improve their physical and
mental health.
Principle 4
It is a contravention of medical ethics for health personnel,
particularly physicians:
(a) To apply their knowledge and skills in order to assist in
the interrogation of prisoners and detainees in a manner that
may adversely affect the physical or mental health or
condition of such prisoners or detainees and which is not in
accordance with the relevant international instruments;
(b) To certify, or to participate in the certification of, the fitness
of prisoners or detainees for any form of treatment or
punishment that may adversely affect their physical or mental
health and which is not in accordance with the relevant
international instruments, or to participate in any way in the
infliction of any such treatment or punishment which is not in
accordance with the relevant international instruments.
Principle 5
It is a contravention of medical ethics for health personnel,
particularly physicians, to participate in any procedure for
restraining a prisoner or detainee unless such a procedure is
determined in accordance with purely medical criteria as
being necessary for the protection of the physical or mental
health or the safety of the prisoner or detainee himself, of his
fellow prisoners or detainees, or of his guardians, and
presents no hazard to his physical or mental health.
Principle 6
There may be no derogation from the foregoing principles on
any ground whatsoever, including public emergency.
________
*1. For the purpose of this Declaration, torture means any act
by which severe pain or suffering, whether physical or
mental, is intentionally inflicted by or at the instigation of a
A1.2
Principles of Medical Ethics, UN General Assembly
public official on a person for such purposes as obtaining
from him or a third person information or confession,
punishing him for an act he has committed or is suspected of
having committed, or intimidating him or other persons. It
does not include pain or suffering arising only from, inherent
in or incidental to, lawful sanctions to the extent consistent
with the Standard Minimum Rules for the Treatment of
Prisoners.
2. Torture constitutes an aggravated and deliberate form of
cruel, inhuman or degrading treatment or punishment.
Article 7 of the Declaration states:
“Each State shall ensure that all acts of torture as
defined in article 1 are offences under its criminal law. The
same shall apply in regard to acts which constitute
participation in, complicity in, incitement to or an attempt to
commit torture.”
A1.3
Appendix 2
Glasgow Coma Scale
GLASGOW COMA SCALE
Component
Response
Score
Motor Response
Obeys verbal command
6
(best extremity)
Localizes pain
5
Flexion-withdrawal
4
Flexion (decortication)
3
Extension (decerebration)
2
No response (flaccid)
1
Subtotal
(1-6)
Eye Opening
Spontaneously
4
To verbal command
3
To pain
2
None
1
Subtotal
(1-4)
Best Verbal Response
Oriented and converses
5
Disoriented and converses
4
Inappropriate words
3
Incomprehensible sounds
2
No verbal response
1
Subtotal
(1-5)
Total
(3-15)
A2.1
Appendix 3
Theater Joint Trauma Record
General
Evidence-based medicine has become the goal of all specialties.
Unfortunately, because of the realities of Combat Trauma, timely
and accurate data collection and interpretation of results are
difficult. Quality information on casualties for combatant
commanders is essential because it facilitates optimal placement,
utilization, and resupply of scarce medical resources, and rapid
identification of new trends in wounding and treatment.
Accurate, aggregated theater information is necessary to shorten
quality improvement cycles in deployed treatment facilities.
Furthermore, these data placed on a website could provide rapid
feedback to the sending physicians, allowing individual follow-
up on their patients. These concepts are not new: they are
routinely employed in the > 1,000 verified trauma centers in
the US. Application of these principles to the battlefield, using
a limited set of jointly approved data elements is described
below. This data collection effort is not designed to be an extra
step. The proposed form can be used as the trauma chart (both
battle and nonbattle injury) and sent to the next evacuation Level
with the casualty.
Situational Awareness
The revolution in warfighting which has digitized the battlefield
to display friendly positions, intelligence, and engagements
electronically has not been equally applied to the casualty side
of the equation. This places demands on medical organizations
to provide online and continuously updated status and location
information on killed, wounded, ill, and psychologically
impaired combatants and noncombatants; which includes both
the casualty loss to the unit and the return to duty patient. This
A3.1
Emergency War Surgery
need will only escalate, as medical situational awareness plays
an increasing role in the tactical risk assessment process. At a
minimum, commanders should be able to assess Killed In Action
(KIA, died before reaching medical care/force wounded) and
Died Of Wounds (DOW, die after reaching medical care/force
wounded) in order to measure risk associated with operations
and the capability of the medical force to control mortality.
No. killed before reaching a BAS
Percentage KIA =
100
No. of casualties (killed + admitted)
No. died after reaching a BAS
Percentage DOW =
100
No. of admitted
Where admitted is defined as any casualty that stays at a
Level II facility or above. These definitions do not include
the carded for record category in the denominator.
A breakdown of casualties by type of injury and the major body
regions (ie, face, head and neck, chest, abdomen and pelvis,
upper and lower extremities, and skin) will enable an analysis
of injury patterns that can be utilized to design interventions
resulting in a decrease in morbidity and mortality.
Other Uses
Data on types of wounds, their causes, and appropriate
procedures have potential value in constructing predictive
models for medical force development and placement, logistical
delivery systems, and research on improved medical interven-
tions. The history of improvements in medicine and surgery
are grounded on the battlefield, and dissemination should not
be limited to the isolated innovator with a personal spreadsheet
for documentation. Individual providers at individual medical
treatment facilities (MTFs) have long recorded clinical data and
observations. This Joint Theater Trauma Record effort is an
extension of their efforts.
A3.2
Theatre Joint Trauma Record
Minimum Essential Data
In addition to recording the standard contents of the postprocedure
note (ie, who did what, on whom, why, and a plan), the standard
data components of a trauma registry are especially helpful (eg,
demographics, circumstance and mechanism of injury, pre-
hospital monitoring and care, hospital monitoring and care,
outcome, participants, direct assessment against standards).
Figure A-1 (see next four pages) is a sample form that can serve
as both the trauma chart and the data entry source. These
minimum essential elements have been agreed on by the US
Army, Air Force and Navy. Data will be collated and placed on
a website at the first Level IV facility in the evacuation chain.
Recommended Methods and Technology
The process to document emergency trauma care can be
employed on either the immature or mature battlefield. This
would entail utilizing paper or computer-assisted electronic
technology, respectively. In the ideal environment, this would
be a single step process. Reality is much different. It is important
to recognize that documentation should occur at all Levels, while
aggregation of data should occur at the first Level that can
support such activity. At a minimum, paper documentation
should be used for each casualty and the chart should
accompany the patient to the rear as evacuation occurs. When
electronic records are available, this process will be simplified.
A3.3
Index
Abdomen
(TACEVAC): 4.1-2
abdominal ultrasound: 17.3-6
medical considerations
antibiotic coverage: 10.8
requirements: 4.2
CT: 17.6˙
noise: 4.5
diagnosis: 17.1-2
phone numbers: 11.7
laparotomy, indications: 17.2
process: 4.8
location: 17.1
thermal stress: 4.5
operation by organ, technique: 17.9-
Aeromedical Evacuation Liaison Team
14
(AELT): 4.6
peritoneal lavage: 17.7
Afterload: 11.8
retroperitoneal injuries: 17.15-16
Aidman, see Combat Medic
wound closure: 17.16
Aircraft, for rapid patient movement,
Abdominal Ultrasound (FAST): 17.3-6
see chapter 4
Abdominal Closure: 12.5; 17.16
Air Evacuation, see chapter 4
in abdominal compartment
Air Force, Level of Care: 2.2
syndrome: 12.5
Air Leak, in Lung Injury: 16.12-13
Abdominal Compartment Syndrome:
Airway Management
12.5; 12.6-7
blind intubation: 5.8
Abdominal Wall Defects: 12.5
chin-lift and head tilt/two handed
Abdominal Pressure: 12.8
jaw thrust/oropharyngeal/
Abscesses, Intraabdominal in Systemic
nasopharyngeal: 5.1
Sepsis: 10.9
cricothyrotomy: 5.6
Acetabulum/Hip Joint Injuries: 21.3
difficulty: 5.6-7
Acetazolamide
endotracheal: 9.5
in eye injury: 14.7
laryngeal mask airway: 5.7
in AMS: 29.26
Air Splints, Problems in Aeromedical
Acidosis
Evacuation: 4.4
metabolic: 11.12
AK-47: 1.7
reversal: 12.6
Albumin, in Burns: 28.6-7
Acute Mountain Sickness (AMS): 29.24-
Alpha Particles: 30.5
27
Alkalosis, Metabolic: 11.12
Acute Renal Failure: 11.9-10
Altitude Illness
dialysis: 11.11
acute mountain sickness (AMS):
in crush syndrome: 22.6
29.24-27
Acute Tubular Necrosis: 11.9
altitude basics: 29.23
Adnexa, uterine: 19.3, 5-7
descent basics: 29.23-24
Adult Respiratory Distress Syndrome
high altitude pharyngitis and
(ARDS): 11.7
bronchitis: 29.27
Aeromedical Evacuation (AE)
high altitude peripheral edema:
aviation environment: 4.3
29.27-28
cabin altitude restriction: 4.4
high altitude pulmonary edema:
concepts of operation: 4.6
29.29-33
decreased humidity: 4.5
subacute mountain sickness: 29.28-
gravitational stress: 4.4
29
head injuries: 15.15-16
thromboembolic events at altitude:
ICU preparation for evacuation:
29.28
11.15
Altitude Restriction: 4.4
intertheater strategic evacuation
Amitriptyline, in Cold Injury: 29.3
(STRATEVAC): 4.1-2
Ampicillin: 10.8
intratheater tactical evacuation
Amputation
xxxi
Emergency War Surgery
indications: 25.1
brachial: 27.5
level: 25.2
descending aorta: 16.7
open length preserving: 25.2
femoral: 27.4
postoperative management: 25.5-6
grafts: 27.7
radiological injury: 30.6
iliac: 27.3
skin traction: 25.5
injury: 27.1-2
technique: 25.3
internal carotid: 13.15
transportation cast: 25.6-8
internal maxillary: 13.7
Anal Laceration: 19.1, 11
popliteal: 27.4-5
Anastomosis
radial: 27.5
colon: 17.3
shunts: 27.6
small intestine: 17.11
vertebral: 13.15
Ancef, see Cefazolin
Arthrotomy: 24.3-5
Anesthesia
Aspiration, of pericardium: 16.3
airway: 9.1
Atrio-Caval Shunt: 17.12
general: 9.6-8
Atropine
field: 9.9-12
chemical injury: 32.2
induction: 9.2
ophthalmic: 14.4
induction agents: 9.3-5
Autotransfusion: 7.11-12
neuroaxial: 9.9
Bacillus Anthrasis, see Anthrax
rapid sequence intubation: 9.2-5
Bacitracin, in Eye Injuries: 14.3
Anesthetics, Effect on Hypotension: 9.5
Bacteria, Infection in War Wounds: 10.2, 5
Anhidrotic Heat Exhaustion: 29.20
Bacterial Agents: 31.5
Ankle
Bacterial Keratitis: 14.5
aspiration: 25.1
Bacteriology, of War Wounds: 10.2-3
disarticulation: 25.4
Ballistics: 1.1-4, 7-9
surgical approach: 24.4
Bandages
Ankle-Brachial Index: 27.2
pressure: 6.2
Anteriorlateral Thoracotomy: 12.12
fibrin: 6.7-8
Anthrax: 31.1-2, 5
Barbiturates
Antiarmor Weapons
anesthesia: 9.4
kinetic energy: 1.10-11
traumatic brain injury: 11.4
landmines: 1.11-13
Battle’s Sign: 13.18
mechanism of injury: 1.12-13
Battalion Aid Station/Level I Medical
shaped charge: 1.9-10
Treatment Facility: 2.1-2
Antibiotics, see also Specific Drugs
Bertylium, in hypothermia: 29.9
head injuries: 15.7
Beta Particles: 30.5
ophthalmic drops: 14.5
Biliary Tract Injury: 17.12-13
ophthalmic ointments: 14.3
Biobrane: 28.14
pediatrics: 33.7
Biological Warfare
prophylactic: 11.14
bacterial agents: 31.5
Anticonvulsants: 15.7
decontamination mechanical/
Antidotes, see chapter 32
chemical/physical: 31.2-3
Antipersonnel Mines, Static/Bounding/
detection and diagnosis: 31.1
Horizontal: 1.6-7
biological toxins: 31.5
Antitoxin, Tetanus: 10.6
infection control/evacuation: 31.3
Anuria: 11.9-12
precautions: 31.4
Arch Bar: 13.5
prevention and protection: 31.2
Arm
quarantine: 31.4
forearm: 22.10-11
viral agents: 31.6
long arm cast: 25.8
Bladder
upper arm: 22.10
dysfunction in spinal cord injury:
Armored Vehicle Crew Casualties: 1.9, 11
20.10
Army, Levels of Care: 2.1-10
injuries: 18.9-10
Arteries
pelvic fracture: 21.2
xxxii
Index
pressure measurement: 12.7-8
phosphorous: 28.11-12
Blast
primary survey: 28.2
mechanisms of injury: 1.4; 1.12-13
respiratory: 28.3
nuclear detonation: 30.1-2, 4
resuscitation management: 28.6-7
over pressure causing CNS injury:
rule of nines: 28.4
15.2
topical chemotherapy: 28.7, 15
Blast Injury
triage: 28.1
brain: 15.2, 11
wound care: 28.7-9
lung: 16.1
BURP Maneuver: 5.4
nuclear detonation: 30.4
Burr Holes: 15.12-13
tympanic membrane: 13.18
Calf
ureter: 18.6
compartments: 22.12
Blood
fasciotomy: 22.13
replacement in shock: 7.3
Caloric Requirements, in ICU: 11.13
massive transfusions: 7.8
Canthotomy/Cantholysis, Lateral: 14.8-9
Blood Products in the Field: 7.6
Capsule, Joint, Closure: 24.4
Blood Bank: 7.6, 9-10
Carbon Dioxide Tension: 19.2, 19.6
Blood Platelets: 7.7
head injuries: 15.10
Blunt Trauma: 1.13
Carbon Monoxide Poisoning, in Burns:
head: 15.1, 13-14
28.3
Boare Flap: 18.6
Cardiac Arrhythmia: 11.8-9
Body Surface, Burned Extent, see Rule of
Cardiac Contractility: 11.8
Nine
Cardiac injury: 16.3
Boric Acid, in Eye Injuries: 14.3
tamponade: 16.3
Botulinum: 31.5
Cardiopulmonary Resuscitation, in
Bougainville Campaign Casualty Data:
Hypothermia: 29.9-10
1.1
Cardiovascular System
Brachial Plexus Block: 9.8
critical care: 11.7-9
Bradycardia
pediatrics: 33.2-3
neurogenic shock: 7.2
Carotid artery
spinal injury: 20.10
ligation in neck wounds: 13.15
Brain
intraoral wounds: 13.15
entrance wounds: 15.2
Casts
primary brain injury: 15.4
air evacuation: 4.3
secondary brain injury: 15.4, 7
application: 25.6
Broad Ligament: 19.5
low hip spica: 25.6-8
Bronchoscopy: 16.14
transportation: 25.6
in airway burns: 28.3
Casualty Evacuation (CASEVAC): 4.1
Brucellosis/Brucella: 31.5
Casualty Receiving and Treatment Ships
Buck’s Fascia: 18.12
(CRTS): 2.4
Bullet, Fragmentation, see chapter 1
Catheter, see chapter 8
Burkholderia Mallei: 31.5
intracranial ventricular: 15.8-9
Burns
pulmonary capillary wedge pressure:
antibiotics: 28.8-9, 13
11.8, 10
armored crew casualties: 1.9
ureteral: 19.9
carbon monoxide: 28.3
urethra: 18.12
chemical: 28.11
Casualty Evacuation: 4.1
electrical injury: 28.10-11
Cavitation, Temporary: 1.1-2, 7-9
epidemiology: 3.9
Cefazolin: 19.13
excision: 28.13
Cephalsporin: 23.2
excision and grafting: 28.12-15
Cefepime: 10.10
first aid: 28.1-2
Cefotetin: 10.8
fluid resuscitation: 28.3-4
Cefoxitin: 10.8
hyperkalemia in: 28.7, 11
Ceftazidime: 10.10
pediatric: 33.3
Ceftriazone: 10.8
xxxiii
Emergency War Surgery
Cellulitis, Anaerobic: 10.6
heat stroke: 29.14, 17
Cerebral Injuries, see Head Injuries
Cold Injury: 29.1-11
Cerebral Perfusion Pressure (CPP): 11.3-4
frost bit: 29.4-7
head injuries: 15.4
frostnip: 29.4
Cervical Spine Injury
hypothermia: 29.7-11
face and neck trauma: 13.2
non freezing: 29.1
field management: 20.4-5
pernio: 29.2
immobilization: 20.6-7
trench foot: 29.2-3
injuries to neck: 20.1-9
Colloids, in burns: 28.5-7
management: 20.9-10
Colon Injuries: 17.13-14
traction: 20.6
colostomy, indications: 17.13-14
Cervical Plexus Regional Block: 9.8
Combat Lifesaver: 2.1
Cervix: 19.3-4
Combat Medic: 2.1-2
Cesarean Section: 19.9, 11-13
Combat Support Hospital (Echelon
Chelating Agents, in Radiological Injury:
Above Corps): 2.10
30.6
Combat Support Hospital/MF2K CSH/
Chemical Agent Monitor (CAM): 32.7
MRI CSH (Corps): 2.6-8
Chemical Injuries
Cooling, in Heat Injury: 29.15
cyanogens: 32.4-5
Common Bile Duct Injury: 17.12
incapacitating agents: 32.5
Compartment Syndrome
initial treatment priorities: 32.1
abdominal: 12.6-8, 10
lung damaging agents: 32.4
calf: 22.12-13
nerve agents: 32.2-3
foot: 26.6-8
off-gassing: 32.6
forearm: 22.10-11
personal protection: 32.1
hand: 26.2-3
post surgical procedure: 32.7
Compazine: 15.3
specific chemical warfare (CW)
Concussion, of brain: 15.2, 10, 11
agents and treatment: 32.2-5
Conjunctiva: 14.6
surgical treatment of chemical
Conray: 18.2
casualties: 32.6-7
Consciousness, see Glasgow Coma Scale
thickening agents: 32.5
Controlled Resuscitation: 7.4
vesicants: 32.3
Convulsions
wound decontaminations: 32.6
brain injuries: 15.7
wound exploration and debridement:
nerve agents: 88
32.6-7
tetanus: 10.4
Chemotherapy, Topical, in Burns: 28.7-8
CONUS, see Level V: 2.10
Chest Tube: 16.4-5
Cooling, in Heat Injury: 29.15
care during evacuation: 3.2, 4
Copper Sulfate: 28.12
Chest Wounds, see chapter 16
Corne
Chilblains: 29.1
abrasion: 14.4
Chlorhexidine gluconate: 28.7
antibiotics: 14.3
Cholecystectomy: 17.12
chemical injuries: 14.3
Cholecystitis, acalculous: 11.13
foreign bodies: 14.6
Cholera: 31.5
ulcer: 14.5
Choledochoenterostomy: 17.3
Coxiella, see Q-Fever
Ciprofloxacin
Cramer Wire Splint: 25.8
eye injuries: 14.2
Craniectomy: 11.4; 15.11
systemic sepsis: 10.10
Craniotomy: 3.9; 11.4; 15.12-15
Clindamycin
Craniocerebral Wounds and Injuries, see
intraabdominal infection: 10.8
Head Injuries
pulmonary infection: 10.8
Creatinine Phosphokinase, in crush
soft tissue wound infection: 10.7
syndrome: 22.7
Clostridial Myonecrosis: 10.6
Cricoid Pressure (Selleck Maneuver): 5.3;
Coagulopathy: 6.6; 11.5
9.5
dilutional: 11.12; 12.6
Cricothyrotomy: 5.2, 5.6-7; 13.2
xxxiv
Index
Critical Care: 11.1
Died of Wounds, definition: appendix 2
Critical Care Air Transport Teams
Difficult airway: 9.6
(CCATTs): 4.9
Dimercaprol: 32.3
role: 11.15
Dislocations, of Cervical Spine: 20.3
Crush Syndrome: 22.6-8
Diuretics, in Crush Injury: 22.8
Crystalloids Fluids: 7.3; 11.4
Dobutamine: 11.3
CT Scan: 15.6; 17.7
Dopamine: 11.3; 20.10
Cyanides: 32.4
Doppler Flow Measurement: 27.2
Cyanomethemoglobin: 32.5
Doxycycline, in Tetanus: 10.6
Cyanogen Chloride: 32.4
Drainage
Cyclogyl: 14.5
bladder: 18.10-1
Cycloplegia: 14.5
CSF: 15.10
Cystography: 18.9-10
kidney: 18.5
Cystostomy: 18.9-10
Drawover Vaporizer: 9.9-12
Damage Control Surgery (DCS)
Dressings
abdomen: 17.12
amputations: 25.5
critical care considerations: 11.1; 12.6-
burns: 28.8
7
soft tissue: 22.5
head injuries: 15.1, 11
Duodenum Injuries: 17.9-10
indications: 12.2
Duplex Ultrasound: 27.2
phases: 11.2
Dura: 15.14
planed reoperation: 12.8
Ebola: 31.5
primary operation and hemorrhage
Echelons of Medical Care, see Levels
control: 12.3-6
Elbow
Debridement
aspiration: 24.3
brain: 15.14
surgical approach: 24.4
frostbite: 29.6-7
Electrical Injury: 28.10-11
necrotizing soft tissue infections:
Embolism, Air: 16.13
10.6-7
Empyema: 16.15
soft tissue: 22.2-4
Endotracheal Intubation
radiological injury: 30.5
aeromedical evacuation: 4.3
soft tissue: 22.2-4
equipment: 9.2
tetanus: 10.6
head injuries: 15.16
war wounds: 10.4
Energy, Kinetic, Antitank Missile: 1.10
Decontamination, Radioactive: 30.6
Enflurane: 9.7
Decubitus Ulcers: 20.10
Endophthalmos: 14.9-10
Deep Vein Thrombosis: 11.12; 20.10
Enucleation, of eye: 14.13
Delayed Triage: 3.2
Enterotomy: 17.13
Delayed Wound Closure
Epidural Block: 9.9
soft tissue: 22.6
Epilepsy: 15.7
radiological injury: 30.5
Epinephrine
Dental Problems with Fractures: 13.4
burn wound excision: 28.14
Dexamethasone
neonatal resuscitation: 19.15
AMS: 29.26
Episiotomy: 19.9-10
HACE: 29.33
Equipment, Triage and Resuscitation
Dialysis, Indications: 11.11
Facility: 3.7
Diaphragm, injuries: 16.15
Erythromycin, in Eye Injuries: 14.3
Diarrhea, Bloody, in Radiation Injury:
Escharotomy
30.4
care: 28.10
Diagnostic Peritoneal Lavage
preferred sites: 28.3
Diamox, see Acetazolamide
thoracic: 28.3
Diazapam
Eschars: 28.3, 9-10
chemical injury: 32.2
Eschmann Stylet: 5.4
heat stroke: 29.16
Esophagus
Diclofenac (ophthalmic): 14.4
injuries and repair: 13.16-17; 16.14-15
xxxv
Emergency War Surgery
fistula: 13.17, 16.15
FFP: 7.6, 8
Etomidate: 5.3; 9.4-5
Field Hospital: 2.9
Evacuation: Precedence by Service: 3.6
Fission Products: 30.5
Excision/Debridement, Inadequate: 22.4
Fixator, External: 28.10-19
Excision, see Debridement.
Flail Chest: 16.1, 4
Expectant, in Triage: 3.2, 3.4
Flash Blindness, in Radiological Injury:
Expeditionary Medical Support Basic
30.5
(EMEDS)/EMEDS + 10, + 25: 2.4, 8
Fleet Hospital: 2.8-9
External Ear, Wound and Injuries: 13.19-
Fluids
20
burns: 28.4-5
External Fixation
intravenous access
ankle: 23.19
Fluorescein: 14.4, 14.6
femoral diaphyseal fracture: 23.10-13
Focused Abdominal Sonography for
humerus: 23.8
Trauma (FAST): 17.3
knee: 23.18
Fogarty Balloon Catheter: 27.6
pelvis: 21.3-4
Foot, Injuries: 26.5-8
tibial shaft: 23.13-17
Forward Resuscitative Surgery Team
Extremity Fractures
(FRSS): 2.5
evacuation: 23.30-31
Forward Surgical Team (FST): 2.3
external fixation: 23.1, 10-20
Foot: 26.1-6
skeletal traction: 23.19-20
Four Cs: 22.4
transportation cast: 23.1, 4-10
Fractures: see chapter 23
wound management: 23.2-4
antitank mines: 1.11
Eye Injuries, Epidemiology: 3.9
naso-orbital-ethmoid (NOE): 13.3
Eyelid, Laceration: 14.10-12
parachute injuries: 1.15
Face
Fracture Table: 23.5-6
airway: 13.1
Francisella, see Tularemia
cervical spine: 13.2
Frostbite: 29.4-7
fractures: 13.3-9
field treatment: 29.5
initial management: 13.1
grades of frost bite/superficial/deep:
lacerations: 13.9
29.4-5
soft tissue: 13.9-11
MFT treatment: 29.5-7
vascular injury: 13.2
Furosemide: 11.10
Facial Bones, Fractures
Gamma Radiation: 30.5
management: 13.1
Gamow Bag: 29.31
mandibular: 13.3
Gardner-Wells Tongs: 20.6-8
mid-face (Le Fort): 13.7-9
Gastritis, stress: 11.5, 12
nose: 13.5
Gastrostomy: 17.10
Facial Nerves
General Hospital: 2.9
anatomy: 13.10
Gentamycin: 10.7, 8
injury: 13.10, 18
Genitourinary Tract Injury
Fallopian Tubes: 19.5
renal: 18.1-5
Fallout, in Nuclear Detonation: 30.5
ureter: 18.6-8
Fasciotomy
bladder: 18.9-10
compartment syndrome: 22.9
urethra: 18.10-12
crush injury: 22.8
external genitalia: 18.12-13
extremities: 22.10-14
in pelvic fractures: 21.2
prophylactic: 22.9
Glanders, see Burkholderia
Fecal Contamination: 17.15
Glasgow Coma Scale
Femoral artery/Vein: 27.3-4
adult: 15.5
Femur: 23.5-6, 23.11-14
modified for children: 33.5
Fentanyl: 5.3; 9.2
Glycopyrrolate (Robinul): 9.7
Fetus
Gray, Unit of Radiation Exposure (Gy):
delivery: 19.9
30.3
heart rate: 19.9, 11
Greater Saphenous Vein Cutdown: 8.3-4
Fever, in ICU: 11.2
Gynecologic/Obstetric Emergencies
xxxvi
Index
Cesarean Section: 19.11-13
Hip Spica, low: 23.5-6
neonatal resuscitation: 19.15
Hoffmann II: 23.10
vaginal delivery: 19.9-11
Hospitals, see chapter 2
vaginal hemorrhage: 19.7-8
Hospital Company 84-Bed, 164-Bed: 2.7-8
uterine atony: 19.13-14
Hospital Ship (TAH): 2.9
Gynecologic Trauma
Hospital Unit-Base (HUB)/Hospital Unit-
abdominal hysterectomy: 19.4-6
Surgical (HUS): 2.7
adnexal injuries: 19.5-6
Humerus: 23.8
ovarian injuries: 19.6
Hydration
retroperitoneal hematoma: 19.7
heat: 29.12
uterus/cervical injuries: 19.3-5
overhydration: 29.12
vaginal injuries: 19.2-3
Hydrogen Cyanide: 32.4
vulval injuries: 19.1-2
Hypaque: 18.2
Halo Immobilization: 20.5-6
Hypercarbia
Halothane: 9.7
CNS trauma: 11.4; 15.7
Hand Injuries: 26.1-4
permissive: 11.7
Hanta Virus: 31.5
Hyperglycemia: 11.5, 14
Head Injuries
Hyperkalemia
combat head injuries type: 15.1-2
burn injury: 9.3, 28-11
evacuation: 15.15-16
crush injury: 22.7
mechanisms of injury: 15.4
heat stroke: 29.17
medical management: 15.7-11
ICU: 11.11
patient assessment and triage: 15.4-7
Hypertension
surgical management: 15.11-15
intracranial: 11.4; 15.10-11
traditional classification of head
systemic: 9.5
injuries: 15.3
Hyperthermia
Hearing: 13.19
avoidance: 11.5
Heart, injuries: 16.12
radiological injury: 30.5
Heat Injury
Hypertonic Saline: 7.3, 5; 11.3
heat cramps: 29.11, 18-19
head injuries: 15.10
heat exhaustion: 29.11, 19-20
Hyperventilation: 11.4
heat stroke: 29.13-1
Hyphema: 14.7
minor heat illnesses: 29.19-22
Hyperphosphatemia: 11.12
presentation of heat stroke: 29-14
Hypocapnea: 15.10
prevention of heat injury: 29.12-13
Hypochlorite Solution: 31.2; 32.3, 6
treatment of heat stoke: 29.15-18
Hypocoagulability, in Trauma: 11.10
Heimlich Valve: 3.4
Hypogastric Artery: 19.7, 14
Helmet: 13.4; 15.2
Hypokalemia: 11.11
Hematoma, head injuries: 15.11, 13
Hypomagnesemia: 11.12
Hemorrhagic Fever, Viral: 31.5-6
Hyponatremia
Hematuria: 18.1, 6, 9
in ICU: 11.11; 28.7
HemCon: 6.7-8
head injuries: 15.8
Hemostasis, of liver wounds,
hypophosphatemia: 11.11
Hemorrhage Control: 17.11
Hypotension: 9.5
Hemorrhagic Fevers: 31.5
Hypothermia
Hemothorax: 16.3
grades: 29.7-8
Hemotympanium: 13.19
in treatment of head injuries: 15.10
Heparin, in Vascular Repair: 27.6
treatment: 29.8-11
Hepatic Failure: 11.13
systemic: 29.7-11
Hepatic Veins, Hemorrhage: 17.12
Hysterectomy: 19.3-5
Hetastarch: 7.3, 5
Ibuprofen
High Altitude Cerebral Edema (HACE):
altitude illness: 29.26
29.31-33
cold injury: 29.6
High Altitude Pulmonary Edema
ICU Care
(HEPE): 29.29-31
cardiovascular system: 11.7-9
Hip: 24.5-6
endocrine system: 11.14
xxxvii
Emergency War Surgery
evacuation: 11.15
Ketamine
gastrointestinal system: 11.12-13
anesthesia: 9.3, 7
hematologic system: 11.12
burns: 28.7
immune system: 11.14
Kidney: 18.1-5
musculoskeletal system: 11.15
Killed in Action, definition: A3.2
pulmonary system: 11.5-7
Kinetic Energy of Missile: 1.10
renal system: 11.9-12
Knee
shock resuscitation: 11.2-3
aspiration: 24.3
traumatic brain injury: 11.3-4
surgical approach: 24.4
Imipenem: 10.8, 10
Kocher Approach: 24.7
Immersion Foot, see Trench Foot
Kocher Maneuver: 17.9, 15
Immobilization, see Extremity Fractures
Laminectomy: 20.2, 9
Immunization, Against Tetanus: 10.4, 6
Landmines
174.175
antipersonnel: 1.6
Infection
antitanks: 1.11
antibiotic coverage for war wounds:
Laparotomy
10.5
epidemiology: 3.9
antibiotic dosage: 10.10
indications: 17.2
diagnosis of wound infection: 10.1
indications, at FST, at CSH: 17.2
intraabdominal: 10.8
Laryngeal Mask Airway (LMA): 5.7-8
microorganisms: 10.2
Laryngoscopy: 5.3-5
patterns of infection: 10.2-3
Larynx, injuries: 13.14-16
pulmonary: 10.8
Laser Eye Injuries: 14.12-13
soft tissue: 10.6-8
Lateral Canthotomy/Cantholysis: 14.8-9
splenectomy: 17.13
Le Fort Fractures: 13.7-9
systemic sepsis: 10.9-10
Levels of Medical Care
tetanus: 10.4, 6
Level I: 2.1
treatment: 10.3-4
Level II: 2.2
Inhalation Injury: 28.2
Level III: 2.6
Improvised Explosive Device: 1.7
Level IV: 2.9
Impact Uni-Vent Eagle: 11.6
Level V: 2.10
Insulin, use in ICU: 11.14
Levoburolol: 14.7
International Quarantinable Disease
Lewisite: 32.3
(IQD): 31.4
Lid Laceration: 14.10-12
Intraocular Contents, Prolaps, see Open
Lidocaine (2% with 1:100,000
Globe
epinephrine): 14.8
Intracranial Pressure: 15.8-10
Ligation: 27.8
Intracranial Ventricular Catheter: 15.8-9
Lenzolid: 10.10
Intraosseous Infusion: 8.4
Internal Jugular Venipuncture: 8.2
Intubation
Litter, in spine injuries: 20.7
rapid sequence for adults: 5.3; 9.5
Liver Injuries: 17.11-12
rapid sequence for children: 33.6
Local Anesthetic Agents: 9.9
direct laryngoscopy: 5.3-5
Log Role: 20.5
endotracheal: 5.10; 9.5
Long Leg Cast: 23.7-8
indications: 9.1; 11.5-6
Lumbar Spine: 20.8
nasotracheal: 5.8
Lung Injuries: 16.12
Isoflurane: 9.7
Lymphocyte/Granulocyte Levels
Jejunostomy: 17.10
Following Radiation: 30.4
Joint Injuries
M-16A1/M16A2: 1.8
aspiration: 24.2-3
M-291 Kit: 32.2
closed: 24.1
Macintosh Blade: 5.3
infection: 24.5
Mannitol
open: 24.1-9
brain injuries: 11.4
surgical approach: 24.5
crush injury: 22.8
Keratitis: 14.5
eye injuries: 14.7
xxxviii
Index
Mafenide acetate: 28.7
Nasolacrimal Duct: 14.12
Mandibular Fractures: 13.3-5
NATO, rifle cartridge 7.62mm: 1.8-9
Mannitol, in head injuries: 15.10
Navy, Levels of Care: 2.4, 2.8-9
Marine Corps, Levels of Care: 2.5
Neck
Maxillary Fracture: 13.6-9
anatomy: 13.12
Maxillofacial Wounds, Reconstruction:
zone: 13.12
13.10
surgical principles: 13.14
Mechanisms of Injury
vertebral artery injury: 13.15
ballistic: 1.3, 12
intraoral injury: 13.15
blast: 1.4, 12
internal carotid: 13.15
thermal: 1.4, 12
internal jugular vein: 13.16
Meconium: 19.15
laryngotracheal: 13.16
Median Sternotomy: 16.9
trachea: 13.17
Medic, Combat: 2.1
esophageal: 13.17
Medical Attendants, in Air Evacuation,
Neostigmine: 9.7
see CCATT
Nephrectomy, Kidney Wounds: 18.3-4
Medical Evacuation (MEDEVAC): 4.1
Nephrostomy: 18.5
Medical Evacuation Precedence: 4.5-6
Neonatal Resuscitation: 19.15
Methergine: 19.14
Nerve Agents
Methylprednisolone, in Spinal Cord
chemical injury: 32.2-3
Injury: 20.9
eye: 14.4
Midazolam: 9.7
Nerves, Contraindication to Repair: 22.4
Metronidazole: 10.6, 8
Neuraxial Anesthesia: 9.9
Miliaria Rubra: 29.20-21
Neurogenic Shock: 7.2; 20.10
Miliaria Profunda: 29.20-21
Nifedipine, in HAPE: 29.31
Military Antishock Trouser (MAST): 6.4
Nitroprusside: 9.5
Miller Blade: 5.3
Nitrous Oxide: 9.7
Minimal Alveolar Concentration (MAC)
Norepinephrine: 11.3
(Halothane, Sevoflurane, Isoflurane,
Nose, fractures: 13.5-6
Enflurane, Nitrous Oxide): 9.7
Nursing Care, Prevention of Decubitus
Missiles, see chapter 1
Ulcers: 20.10
Mobile Field Surgical Team (MFST): 2.3
Nutrition, in ICU: 11.13
MOPP Gear
Obstetrical/Obstetric Emergencies: 19.8-
in heat: 29.13
14
chemical injury: 32.1
Ocuflox (ophthalmic drops): 14.5
Mortality
Ocular Injuries
burns: 28.1
anterior segment injuries: 14.3-7
damage control surgery: 12.1
chemical injury: 14.3-4
radiological injury: 30.3-4
corneal abrasions/ulcer: 14.4-5
Multiple Injuries, with head injuries: 15.3
hemorrhage: 14.7-8
Muscle Relaxants
hyphema: 14.7
depolarizing: 9.3
foreign bodies: 14.6
nondepolarizing: 9.3
identifying: 14.1-2
Mustard
open globe: 14.2-3
chemical injury: 32.3
retrobulbar/orbital floor fracture:
treatment of eye injuries gas: 14.4
14.9-10
Mydriacil: 14.5
subconjunctival hemorrhage: 14.3
Myocardial Ischemia/Infarction: 11.9
Ohmeda Portable Anesthesia Complete
Myoglobinuria: 11.10; 28.11
(PAC): 9.9-11
crush syndrome: 22.7
Oliguria, in renal failure: 11.9
electrical injury: 28.11
Omnipaque: 18.2
heat stroke: 29.14, 17
Op-Site: 28.14
Naloxone, in Neonatal Resuscitation:
Open Joint Injuries
19.15
acetabulum in pelvic fractures: 21.3
Naso-Orbito-Ethmoid Fracture: 13.3
anterior iliofemoral approach: 24.6
xxxix
Emergency War Surgery
aspiration/injection: 24.2
Pelvis, Drainage: 17.15
hip: 24.5-8
Penicillin
operative treatment: 24.2-4
in tetanus: 10.6
posterior/Kocher approach: 24.7-8
in necrotizing soft tissue infection:
shoulder: 24.8-9
10.7
Open Pneumothorax: 16.4
Pernio: 29.2
Optiray: 18.2
Penis, Wounds: 18.12
Opthalmia, Sympathetic: 14.13
Pericardial Tamponade: 16.3
Orbit
Pericardial Window: 16.7-9
blowout fracture: 14.9
Pericardiocentesis: 16.3
hemorrhage: 14.7
Peripheral Nerves: 22.4
Oropharyngeal Intubation: 5.4-6
Peritoneal Lavage, diagnostic (DPL): 17.7
Osmolarity: 11.4
Perirectal Space: 17.15
Otologic Blast Injury: 13.19-20
Peritonitis: 10.8
Oxygen, supplemental: 11.5
Permanent Cavity: 1.3
Oxygen Tension
Phenergan: 14.3
aeromedical evacuation: 4.4
Phenobarbital: 9.4
critical care: 11.7
Phenylephrine: 11.3; 20.10
head injury: 15.7
Phenytoin: 11.5
Oxytocin
Phlebotomy: 7.6-8
postpartum: 19.13
Phosgene: 32.4
Uterine atony: 19.14
Phosphorus, White: 28.11-12
Ovarian Cyst: 19.6
Physostigmine: 32.5
Ovarian Torsion: 19.7
Plague: 31.2, 3, 5
Ovaries: 19.6-7
Plaster Casts: 23.4-7
Packing, Abdomen: 12.4-5
Platysma: 13.13
Pain, Control in ICU: 11.2
Pneumothorax
Pancreatic Duct: 17.11
open: 16.4
Pancreas Injuries: 17.10-11, 14
surgical management: 16.4-6
Pancreaticoduodenectomy: 17.9, 11
tension: 16.1, 3
Pancuronium: 9.3
Polysporin, in eye injuries: 14.3
Parachute Injuries: 1.14-15
Popliteal Artery: 27.4-5
Parotid Duct Injury: 13.11
Position of Function, Hand: 26.4
Patching, Eye Injuries: 14.2
Positive End-Expiratory Pressure (PEEP):
Patient Movement Requirement Center
9.6; 11.6
(PMRC): 4.7
Posterolateral Thoracotomy: 16.12
Pediatric Care
Potassium, see Hypo/Hyperkalemia
burns: 33.3
Potassium Iodine, in Radiological Injury:
cardiovascular: 33.2-3
30.6
drug/dosage: 33.7
Pralidoxime Chloride (2-PAMCl): 32.2
fluid requirements: 33.1
Precautions, Biological Weapons,
gastrointestinal: 33.3
Standard/Droplet: 31.4
hematology: 33.4
Prednisolone, Ophthalmic: 14.4, 7
intubation: 33.6
Pregnancy: 19.8-14
pulmonary: 33.2
Preload: 11.8
Pelvic Fractures
Presacral Drainage: 17.15
acetabular fracture: 21.3
Pressure
associated visceral injuries: 21.2-3
abdominal compartment syndrome:
blunt: 21.1
12.7
characteristics of penetrating
cerebral perfusion: 11.3-4
wounds: 21.3
intracranial: 11.4
external fixation: 21.3-4
mean arterial (MAP): 11.4
hemorrhage control: 21.2
intraocular: 14.7
Pelvic, Wounds Associated with Hip Joint
Pressure Points for Hemorrhage Control:
Injury: 21.3
6.3
xl
Index
Pressurization of Aircraft: 4.4
Respirator, in Air Evacuation: see chapter
Primary Injury of the Brain: 15.4
22
Pringle Maneuver: 17.11
Respiratory Complications Due to Nerve
Prochlorperazine, in Altitude Illness:
Agents: 32.2
29.26
Respiratory Irritation, see chapter 32
Proctoscopy: 17.14
Respiratory Obstruction, Emergency
Propofol: 9.4
Care, see chapter 5
Proptosis: 14.2
Respiratory Restriction, Escharotomy:
Protein Requirements: in ICU: 11.13
28.3
Prussian Blue, in Radiological Injury: 30.6
Resuscitation, see chapter 7
Pretreatment with Pyridostigmine
organization of facility: 3.13
Bromide: 32.3
Resuscitative Thoracotomy: 16.6-7
Pseudomonas Antibiotic Therapy, see
Retinal Injuries: 14.12
chapter 11
radiological injury: 30.5
Psoas Hitch: 18.6-7
Retroperitoneal Injuries: 17.15-16; 18.1, 3,
PTFE Graft: 27.7
6; 19.7
Pulmonary Infection: 10.8-9
Rewarming
Pulmonary Insufficiency
cold injured parts: 29.5-6
critical care: 11.5-7
hypothermia: 29.9-10
pediatrics: 33.2
Rib Fractures: 16.4; 17.4; 18.1
Pulmonary Tractotomy: 12.6; 16.13
Ricin: 31.5
Pulse After Arterial Repair: 27.9
Rifle, Bullets, see chapter 1
Pulse, in Shock: 7.1-2
Rift-Valley Fever: 31.5
Pupils: 14.2; 15.6
Rine Test: 13.19-20
Pyelography, Intravenous: 18.9
Rocuronium: 9.4
Pylorus, Ligation: 17.10
Role of Medical Care, see Levels
Pyrexia, see chapters 10 and 11
Round Ligament: 19.5
Q-Fever: 31.5
Roux-en-Y: 17.9-16
Quik Clot: 6.7-8
RPG-7: 1.10
Radial Artery: 6.3
Rule of Nines
Radiation Dispersal Device (Dirty Bomb):
adult: 28.4
30.1
child: 33.3
Radiation, Lethal Dose: 30.3
Sacrum
Radiological Injury
decubitus ulcers: 20.10
combined injuries: 30.5-6
presacral drains: 17.15
decontamination: 30.6
Saphenous Vein: 8.3-4; 27.7
introduction: 30.1-2
Salpingectomy: 19.5
logistics: 30.6-7
Scalp, Laceration: 15.3
potential injuries: 30.4-5
Sciatic Nerve: 24.7
signs and symptoms: 30.3
Scopolamine, ophthalmic drops: 14.4; 4, 7
triage: 30.2-3
Scrotum, Wounds: 18.12
Rhabdomyolysis: 28.11
Secondary Injury of the Brain: 15.4, 7
crush syndrome: 22.6
Seizure, Prophylaxis: 11.5
heat stroke: 29.14, 17
Seldinger Technique: 8.2-3
Rapid Sequence Intubation (RSI): 5.3; 9.5
Sepsis, see chapters 10 and 11
Rectal Injuries: 17.14-15
Septic Shock: 7.2
Rectovaginal Septum, Repair: 19.11
Sevoflurane: 9.7
Rectum: 17.14-15; 19.4
Shock and Resuscitation
Regional Anesthesia: 9.8-9
clinical correlates of hypovolemic
Renal Dialysis, in Crush Injury: 22.7
shock: 7.2
Renal Failure: 11.9-12
colloids: 7.5
Renal Injuries: 18.1-5
concept of controlled resuscitation:
Renografin: 18.2
7.4
Reoperative Abdominal Surgery: 12.8-9
fluids for resuscitation: 7.5
Resection, of small intestine: 17-13
recognition and classification of
xli
Emergency War Surgery
shock: 7.1-2
head injuries: 15.7
resuscitation: 11.2-3
instability: 20.3-4
transfusion therapy: 7.6-12
management principles: 20.10
treatment of traumatic shock: 7.2-4
pathophysiology: 20.2
walking blood bank: 7.6-8
patient transport/extrication: 20.2-5
Shock Trauma Platoon: 2.2
stability: 20.2
Shock Wave
treatment: 20.9
in ballistic injury: 1.3
Splenic Injury: 17.11, 13
in blast: 1.3-4
Splints, Extremities: 28.15
Shunts: 27.6
Staphylococci: see chapter 10
Shoulder
Steinmann Pins: 23.19
aspiration: 24.3
Sternotomy: 16.9
splinting: 24.8
Steroids
surgery: 24.8-9
contraindication in traumatic brain
Sildenafil, Use in High Altitude
injury: 11.4
Exposure: 29.24
injuries of the spine: 20.9
Silver Sulfadiazine: 28.7
trauma: 11.15
Skeletal Traction: 23.19-20
treatment of toxic fumes: 1.13
Skin Grafts, Burns: 28.12-15
Stomach: 17.9
Skull
Streptococcal in Necrotizing Soft Tissue
basilar fracture: 13.18
Infection: 10.6
scalp: 15.3
Stress
skull: 15.3, 6
triage: 3.4
Skull Base, Temporal Bone and Otologic
in medical personnel: 3.7
Injury: 13.18-20
Stryker Frame: 20.8
Small Bowel Injuries: 17.13
Subclavian Vein Venepuncture: 8.1-2
Small Intestine: 17.13
Subconjunctival Hemorrhage: 14.3
Small Portable Expeditionary
Subxiphoid Pericardial Window: 16.7-8
Aeromedical Rapid Response (SPEARR)
Succinylcholine: 5.3; 9.3
team: 2.4
contraindication: 9.3
Smallpox: 31.2, 5
malignant hyperthermia: 9.3
Sodium, Fractional Excretion (FENA):
Sucking Chest Wounds: 16.4
11.10
Sulfadiazine: 28.7
Sodium Bicarbonate: 11.10
Sulfamylon: 28.7-8, 15
Sodium Nitrite/Thiosulfate: 32.5
Supplies, Triage and Resuscitation
Soft Tissue Injuries
Facility, see chapter 2
care after initial surgery: 22.5-6
Surgical Company: 2.5
compartment syndrome: 22.9-10
Surgicel: 17.12
crush syndrome: 22.6-8
Symes Amputation: 25.4
debridement: 22.2-4
Synovium: 24.4
face: 13.9
Systemic Inflammatory Response (SIRS)
fasciotomy technique: 22.10-14
disease: 11.2
primary wound care: 22.2-5
Tactical Abbreviated Surgical Control
presurgical care: 22.1
(TACS): 12.1
priorities: 22.1-2
Tanks, Crew Injuries: 1.9
Sonography, see Ultrasound
Temazepam, in Altitude Insomnia: 29.27
Sorting, see chapter 3
Temporary Cavity: 1.3, 7-8
Spall: 1.10
Tendons, Contraindication to Repair: 22.4
Spica Cast: 25.6-8
Tension Pneumothorax: 5.3
Spinal Column and Cord Injuries
Testicles: 18.13
classification: 20.2-3
Tetanus Immune Globulin: 10.6
corticosteroids for closed spine
Tetanus Toxoid: 14.3
injuries: 20.9
cold injury: 29.6
emergent surgery for penetrating
tetanus-prone wounds: 10.6
spine injuries: 20.9
Thermal Injury: 1.4
Gardner-Wells tongs: 20.6-8
in nuclear detonation: 30.1-2
xlii
Index
Thermobaric Weapon: 1.4
tips: 3.14-15
Thickening Agents: 32.5
triage decision making: 3.7
Thigh, Compartments and Fasciotomy:
Triazolam, in Altitude Insomnia: 29.27
22.11
Trismus, in Tetanus: 10.4
Thiopental: 9.4
Trunk, Circumferential Burns: 28.3
Thoracic Injuries
Tube Thoracostomy 16.4
evaluation and diagnosis: 16.2
Tularemia: 31.5
diaphragm: 16.15
Tympanic Membrane, Injuries: 13.19
esophagus: 16.14-15
Ultrasound
heart: 16.12
abdominal: 17.3
lungs: 16.12-13
duplex: 27.2
thoracic damage control: 12.6
Unexploded Ordnance: 1.13-14
tracheobronchial tree: 16.14
Uranium, depleted: 1.10
Thoracic Spine: 20.8
Ureter: 18.6-9
Thoracoabdominal Injuries: 16.11
Ureteroneocystostomy: 18.8
Thoracostomy: 16.4
Ureteroureterostomy: 18.7-8
Tibia: 23.13-17
Urethra
Tidal Volume: 9.6; 11.6
injuries: 18.10-12
Timolol Ophthalmic: 14.7
pelvic fracture: 21.2
Tinnitus: 13.19
Urethral Stricture: 18-12
Toe Injuries: 26.6
Urethrography: 18.10-11
Tooth
Urinary Diversion: 18.4, 6
fragments 13.1
Urine
removal 13.4
characteristics in crush injury: 22.7
Topical Antimicrobials, see chapter 28
characteristics in renal failure: 11.9-12
Total Intravenous Anesthesia: 9.7
Uterine Hemorrhage
Tourniquet: 6.3-4
atony: 19.13
Toxic Fumes, in Damaged AFV: 1.13
indication for C-section: 19.11
Tracheal Injury: 13.16
postpartum: 19.13-14
Tracheobronchial Injury: 16.14
Uterus, Injuries: 19.3
in burns: 28.2
Vacuum wound closure sytem: 22.14
Traction
Vagina
cranial tongs: 20.6
hematoma: 19.3
skeletal: 23.19-20
injuries: 19.2-3
skin: 25.5
mass: 19.8
Transfusion Therapy: 7.6
precipitous delivery: 19.9
massive: 7.8-9
Vancomycin: 10.10
Transfusion Reactions
Valium, Heat Stroke: 29.16
management: 7.7
Vascular Access
Rh blood group and females: 7.7-8
interosseous infusion: 8.4
Trauma Record
techniques subclavian vein/internal
data collection: A3.4-7
jugular/greater saphenous: 8.1-4
died of wounds: A3.2
Vascular Injuries
killed in action: A3.2
complications: 27.8-9
Trenchfoot: 29.2-3
compartment syndrome: 22.9-14;
Triage
26.2, 6-8
alternate triage categories (emergent,
evaluation and diagnosis: 27.1-2
nonemergent, expectant): 3.3
hemorrhage control: 27.3
categories (immediate, delayed,
management: 27.3-8
minimal, expectant): 3.2
postoperative management: 27.8-9
combat stress: 3.4
repair: 27.6-7, 10; 13.2
decision making: 3.8
shunts: 27.6
radiation injury: 30.2-3
Vasoconstrictors, in Distributive Shock:
resource constraints: 3.5-7
7.2
setup, staffing and operations of
Vasopressors
triage system: 3.9-14
dobutamine: 11.3
xliii
Emergency War Surgery
ephedrine: 9.5
Walking Blood Bank: 7.9-11
norepinephrine: 11.3
Work-Rest Cycles, in Heat/FM21-10/
neosynephrine: 9.5
MCRP 4-11.1D: 29.12
phenylephrine: 11.3
Weapons Effects
shock: 11.3
antiarmor: 1.9
Vecuronium: 9.3, 7
antiarmored weapons: 1.9-13
Vein Grafts: 27.7
antipersonnel mines: 1.6-7
Veins
blast: 1.4
greater saphenous: 8.3-4
distribution of penetrating wounds:
internal jugular: 8.1; 13.15
1.2
repair: 27.8
epidemiology: 1.1-2
subclavian access: 8.1
grenade: 1.1
Velpeau Dressing: 23.8-9
landmines: 1.1, 6
Vena Cava, Intrahepatic, Hemorrhage:
mechanism of injury: 1.2
17.12
missiles: 1.2-5
Venezuelan Equine Encephalitis (VEE):
shaped charge: 1.9
31.5-6
specific small arms: 1.7-9
Ventilation
thermal: 1.4, 12
bag valve mask: 5.2
unexploded ordnance: 1.13-14
hyperventilation: 11.4
Weather, Role in Cold Injury: 29.7
indications: 11.5-6
Webril: 23.6, 8
mechanical in ARDS: 11.7
Wound Ballistics, see chapter 1
positive pressure: 5.3
Wound
Ventilator
closure: 22.5-6
field: 9.10; 11.6
radiation injury: 30.5
Impact Uni-Vent Eagle: 9.10; 11.6
soft tissue: 22.2-5
rate: 11.6
vacuum wound closure system: 22.14
Ventricular Fibrillation, hypothermia:
Wound Data and Munitions Effectiveness
29.9-10
Team (WDMET) Casualty Data: 1.1
Vercuronium: 9.3
Wounds/Injuries
Versed: 9.7
anatomical distribution: 1.2; 3.9
Vertebral
decontamination: 32.6
artery: 13.14
location, antitank mine: 1.8
column: 20.3
management in radiological injury:
fracture and renal injury: 18.1
30.5
Vesicants: 32.3
parachute: 1.15; 30.5
Viagra, see Sildenafil
Wrist Block: 9.8
Vibro Cholera, see Cholera
Xeroform Gauze: 28.14
Viral Agents: 31.5-6
Yaw: 1.5
Visual Acuity, Evaluation: 14.1
Zosyn (Piperacillin and Tazobactam):
Vomiting, Radiation Injury: 30.6
10.10
Volume, tidal: 9.6; 11.6
Vulva
hematoma: 19.2
injuries: 19.1
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