Operational Medicine Medical Education and Training

Medical Aspects of the Urban Combat Environment

What Makes Medical Care In This Environment Different?

Multi-Etiologic / Multi-System Injury Common

High Degree of wound contamination

Long delays between time of wounding and surgery common

Hostile care environment - Fire superiority is best medical care in a firefight

"Reverse Triage" - Treat least wounded first to maintain firepower

What Makes Medical Care In This Environment Different?

Weight and Bulk considerations for medical supplies / equipment

Only what can be carried on back is available

Multi-casualty situations common

Treatment is provided in echelons

Medical Aspects of the Urban Combat Environment

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Planning Factors In MOUT

Expect helicopter evacuation to be unavailable

Plan on long delays between wounding and surgery [>6 hr] unless surgery is done in the city

Plan on limited-to-no enroute medical care

Expect large numbers of casualties

Plan on casualties arriving with explosive munitions/weapons - On and in them

Plan for dealing with embedded munitions

Mogadishu Raid

Casualty Evacuation Issues

Helicopter evacuation impossible

Congested urban environment

High probability of being shot down

Ground extraction difficult/impossible

Congested urban environment ideal for ambushes and road-blocks. Navigation difficult.

High probability of being shot

Delayed evac leads to higher infection rate

Have medics administer antibiotic near point of wounding

Mogadishu Raid

Casualty Evacuation Issues

Loading of casualties

Critical casualties last on, first off

Inability to provide enroute care - medics not available, non-medical vehicles used, circumstances of combat

"Evacuation of Dead" - Not just a "Quartermaster Issue." Use dead as "sandbags" around living wounded

Unloading casualties

Problems with rapid identification of most serious casualties

Continue to the PowerPoint Lecture...

Col. Cliff Cloonan USA MC


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