Operational Medicine Medical Education and Training

Immediate Care of the Wounded

Clifford C. Cloonan, M.D., FACEP
Colonel (ret) Medical Corps
United States Army

Serving 30 years in the US Army, Colonel Cloonan is among the most knowledgeable of military physicians in immediate care. He has served as:

  • Infantryman

  • Special Forces Medic

  • Flight Surgeon

  • Division Surgeon

  • Chief of Emergency Medicine

  • Dean of the Joint Special Operations Medical Training Center

  • Interim Chairman of the Department of Military and Emergency Medicine at the Uniformed Services University

  • Consultant to the Surgeon General for Emergency Medicine

Dr. Cloonan has observed that:

  1. The simple answer is the right answer.

  2. Well-performed basic techniques are usually better for the patient than more complicated techniques.

  3. Conscious inaction is better than mindless action.

  4. Training is more important than equipment.

  5. when a procedure is taught, particularly one that seems "heroic" (e.g. cardiac massage), that the procedure will be performed much more often than indicated.

  6. If you are looking for the solution to a problem the first place to look is in the past because there is a good chance that someone else either already solved the same or a similar problem or at least was able to find out what didnít work.



This definitive text describes the history of wounding, mechanisms of injury, historical missteps, and current treatments for injuries sustained in military and operational settings. It is a culmination of his knowledge, accumulated through first-hand experience and a lifetime dedicated to the study of these issues. This is must-read material for those medical personnel working with the wounded within minutes of injury, and those who train these front-line Medics, Hospital Corpsmen and EMTs.


Introductory Thoughts

  • Introduction
  • Acknowledgements
  • About the Author


  • Introduction
  • History of Airway Management
  • Frequency of Airway Obstruction in Civilian Populations
  • Frequency of Airway Obstruction in Combat
  • Indications for Airway Management at Point of Wounding
  • Prophylactic Airway Management
  • Responsibility for Airway
  • Management at Point of Wounding
  • Decision Making in Airway Management
  • The Technical Imperative
  • Airway Management Proce3dures
  • Basic Airway Management
  • Body Position
  • Advanced Airway Management
  • References


  • History and Epidemiology of Thoracic Injury and Respiratory Impairment in Combat Casualties
  • Epidemiology of Civilian Thoracic Trauma
  • Physiology and Pathophysiology of Ventilation, Oxygenation, and Respiration in Combat Casualties
  • High Altitude (environmental) Hypoxia
  • Hypoventilation
  • Ventilation - Perfusion (V/Q) Mismatch
  • Anemic Hypoxia
  • Circulatory (stagnant) Hypoxia
  • Histiocytic Hypoxia
  • General Approach to the management of a Combat Casualty with Possible Impairment of Ventilation, Oxygenation, and/or Respiration
  • Initial Assessment and Management of the Thoracic Wounded Casualty
  • History
  • Physical Examination
  • Auscultation
  • Use of ultrasonography to detect lung injury
  • Pulse Oximetry
  • Pre-Hospital Assessment of Thoraco-Abdominal Injury
  • Assessment of Shock in Thoracic Wounded Casualties
  • General Management of Thoracic Wounded Casualties
  • Oxygenation and Ventilation of Thoracic Wounded Casualties
  • Specific Mechanisms of Combat-related Injury Associated with Impairment of Ventilation, Oxygenation, and/or Respiration and their Management
  • thoracoabdominal and Diaphragmatic Injury
  • Penetrating Chest Trauma
  • Blast Lung
  • Circumferential Burns of the Chest Wall
  • Triage and Evacuation of Casualties with Oxygenation and Ventilation Problems.


  • Hemorrhagic Shock
  • Types of Shock
  • Stages of Shock
  • Compensated Shock
  • Decompensated Shock
  • Irreversible Shock
  • Individual Manifestations of Shock
  • Identifying the patient in Hemorrhagic Shock at or near the Point of Wounding.
  • Specific Tests for Shock
  • Fluid Resuscitation
  • Non-blood fluids
  • Transfusion near the Point of Wounding
  • Blood substitutes
  • Pneumatic Antishock Garment
  • Hemorrhage Control
  • Other Types of Shock


  • Overview and Epidemiology of Head and Spine Injury
  • Head Injury
  • Neck Injury
  • Injuries Involving the Spinal Cord
  • Civilian vs. Military Spine Injuries
  • Definition of Instability
  • Influence of Mechanism of Injury on Spine Instability
  • Frequency of Spinal Cord Injury and Instability in Penetrating Trauma
  • Diagnosis
  • Clearing the Cervical Spine at or near the Point of Wounding
  • Probability of Spine Injury in Patients with other Injuries above the Clavicle
  • Clinical Findings in Cervical Spine Injury
  • Spine Injury Treatment
  • Care of the Casualty with Head Trauma

Immediate Care of the Wounded

Clifford C. Cloonan, M.D., FACEP

Colonel (ret) Medical Corps,

United States Army


Complete Monograph
246 Pages
2.8 MB pdf

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