Trauma-damage control surgery:
post-operative care
George Merridew
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 multiplyresistant 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 postoperative 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 welldesigned clinical protocols. Most transfers from Iraq to Germany are in C-17 Globemaster pure jet aircraft, with a flight time of 5 hours.
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