02-Trauma Control Surgery-Trauma-damage control surgery: post-operative care

By George Merridew In   Issue Volume 16 No. 2 .

Aims in post-operative care after multiple trauma:

  • Maintain the progress of substantial surgical and other treatments already given
  • Seek then treat any additional problems as they develop

In military practice, those aims are addressed by conventional timely management in a surgical intensive care unit, pending evacuation to a higher level of care as soon as the patient is sufficiently stable and suitable transport medical capability is available. Typically, Coalition casualties from Iraq arrive at a US military hospital ICU in Germany by 24-36 hours after injury. When given expert overall management, patients with severe multiple injuries can have a remarkably high survival rate. My observation in 2005 was that almost all post-operative patients at Balad Air Base (Iraq) reached Germany alive and had had few untoward events either in the Balad ICU or in flight. The most common post-operative serious complication recognised at Balad appeared to be pulmonary embolism and that was despite assiduous prophylaxis. A more subtle problem was of multiply-resistant Acinetobacter species in patients in whom the organism was not isolated until after arrival in Germany or continental USA. Acinetobacter is a feared cause of hospital-acquired infection in the USA, but did not appear to cause us trouble, even in long-stay (Iraqi) patients in our Balad ICU.Every day, an average of about 3 ventilated post-operative patients were delivered to Germany from Balad. Their smooth management reflects the disciplined application by specialist USAF Critical Care Air Transport Teams (CCATT) of their well-designed clinical protocols. Most transfers from Iraq to Germany are in C-17 Globemaster pure jet aircraft, with a flight time of 5 hours.The ADF too aims for expert early surgical and post-operative care of critically injured patients, including their evacuation. The evolution of our AME capability includes:

  • Accessing electricity from the C130 Hercules power system
  • Acquiring C-17 aircraft to complement the RAAF C130 fleet
  • Clinical experience in Iraq and Afghanistan
  • CCATT training in USA of key ADF Health staff
  • Establishing a CCATT-equivalent RAAF system
  • Participation by the ADF in international and Australian national consultations with military and civilian groups with clinical, aviation and logistic expertise in prolonged transport of critically ill patients.

Contact author:  GPCAPT George Merridew, PO Box 1328, Launceston, Tas 7250

Email: [email protected]

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