April Michael D, Schauer Steven G, Long Brit, Hood Lyle, De Lorenzo Robert A
Uniformed Services University of the Health Sciences, Bethesda, MD, and 40th Forward Resuscitation and Surgical Detachment, 627 Hospital Center, 1st Medical Brigade, Fort Carson, CO.
Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; Medical Command, Texas Army National Guard, Austin, TX; United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; and Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX.
Med J (Ft Sam Houst Tex). 2023 Jan-Mar(Per 23-1/2/3):18-27.
Large-scale combat and multi-domain operations will pose unprecedented challenges to the military healthcare system. This scoping review examines the specific challenges related to the management of airway compromise, the second leading cause of potentially preventable death on the battlefield. Closing existing capability gaps will require a comprehensive approach across all components of the Joint Capabilities Integration Development System. In this, we present the case for a change in doctrine to selectively provide definitive airway management in prehospital settings to maximize the effectiveness of limited resources. Organizational changes to optimize training and efficiency in delivery of complex airway intervention include centralization of assigned healthcare personnel. Training must vastly increase opportunities for live tissue and patient experiences to obtain repetitions of both non-invasive and definitive airway procedures. Potential materiel solutions include extra-glottic devices, bag-valve masks, video laryngoscopes, and oxygen generators all ruggedized and capable of operations in austere settings. Leadership and education changes must formalize more robust airway skills into the initial training curricula for more healthcare personnel who will potentially need to perform these life-saving interventions. Simultaneously, personnel changes should expand authorizations for clinicians with advanced airway skills to the lowest echelons of care. Finally, existing medical training and treatment facilities must expand as necessary to accommodate the training and skill maintenance of these personnel.
大规模作战和多域作战将给军事医疗系统带来前所未有的挑战。本范围综述探讨了与气道梗阻管理相关的具体挑战，气道梗阻是战场上潜在可预防死亡的第二大原因。弥合现有能力差距需要在联合能力集成开发系统的所有组成部分采取综合方法。在此，我们提出改变原则的理由，以便在院前环境中有选择地提供确定性气道管理，从而最大限度地提高有限资源的使用效率。为优化复杂气道干预的培训和实施效率而进行的组织变革包括集中分配医疗人员。培训必须大幅增加活体组织和患者体验的机会，以便对无创和确定性气道程序进行反复操作。潜在的物资解决方案包括声门上装置、袋阀面罩、视频喉镜和制氧机，所有这些设备都经过加固，能够在艰苦环境中运行。领导和教育方面的变革必须将更强大的气道技能正式纳入更多可能需要进行这些救生干预的医疗人员的初始培训课程。同时，人员配置方面的变革应将具有高级气道技能的临床医生的授权扩大到最低护理层级。最后，现有的医疗培训和治疗设施必须根据需要进行扩展，以满足这些人员的培训和技能维持需求。
