How Shall We Train for Combat Casualty Care?

What medical skills are needed for combat casualty care? One approach to this question is to ascertain the salient medical features of combat casualties by studying actual case reports. This paper contains a list of all casualties in three company/battalion-size engagements that occurred in the Vietnam conflict as recorded by the Wound Data and Munitions Effectiveness Team. In terms of the total casualty population, 17% were killed in action, 2% died of wounds, 48% sustained nonfatal wounds requiring admission, and 33% were carded for record only. Penetrating missiles were the wounding agent in the overwhelming majority of casualties. More than half of the survivors had uncomplicated soft tissue wounds, about one-fourth had complicated injuries requiring laparotomy, craniotomy, or vascular reconstruction, and the remainder had open fractures. Surprisingly few casualties, even when those killed in action are considered, would have benefited from the emergency life-saving skills emphasized in the Advanced Trauma Life Support Course. Training for combat casualty care would be improved if 1) simulated casualty populations were based upon actual combat casualties rather than civilian trauma victims and if 2) training emphasized the skills necessary to perform war surgery, especially the treatment of soft tissue wounds.