Elsevier

Critical Care Clinics

Volume 25, Issue 1, January 2009, Pages 31-45
Critical Care Clinics

Battlefield Trauma, Traumatic Shock and Consequences: War-Related Advances in Critical Care

https://doi.org/10.1016/j.ccc.2008.10.001Get rights and content

Over the course of history, while the underlying causes for wars have remained few, mechanisms of inflicting injury and our ability to treat the consequent wounds have dramatically changed. Success rates in treating war-related injuries have improved greatly, although the course of progress has not proceeded linearly. From Homer's Iliad to the Civil War to Vietnam, there have been significant improvements in mortality, despite a concurrent increase in the lethality of weapons. These improvements have occurred primarily as a result of progress in three key areas: management of wounds, treatment of shock, and systems of organization.

Section snippets

Wound care

The anthropologic record illustrates that care of traumatic wounds predated written history. Skulls uncovered in the Tigress-Euphrates Valley, the shores of the Mediterranean, and in meso-America show that trepanation was used to treat skull fractures and possibly epidural hematomas as far back as 10,000 bc.1 Healing of man-made holes in these specimens suggests that the procedure was performed with some degree of success.3 Fractures and dislocations were treated with knitting of bones.

The

Shock

Until recent history, the concept of shock was poorly understood. Very little description of or reference to shock occurs in the ancient or medieval texts. It was clear from the Smith Papyrus that the Egyptians understood the heart to be the center of circulation, a concept that would be lost for millennia. However, the significance of this fact was not understood. The Romans, as referred to by Pliny in his Historia Naturalis, describe the use of “ma huang”1 or ephedra, which suggests one of

Organizational systems and transport

Organizational systems for the treatment of wounded soldiers in ancient Egypt and early Greece did not exist. Care was primarily given on the field of battle by fellow soldiers. Occasionally, care was provided by physicians, but they too were fighting on the front lines, many themselves injured. The Greeks ultimately did develop a rudimentary trauma system, with the wounded treated in special barracks or “klisiai.”1

In the first and second centuries AD, the Romans reintroduced the concept of a

Conclusion

While progress in the management of battlefield trauma from ancient times to the present has certainly been great, it has not been linear. Several factors have facilitated progress. Knowledge sharing has clearly played a role. Cross-cultural dispersion among geographically related (Egyptians, Greeks, and Romans) or the economically related (Romans and Chinese via the Silk Road) cultures are examples. Dissemination of information across generations, such as seen in the Asclepiades of

Summary

Evolution and progress in wound care, treatment of shock, and systems of organization are useful areas of study and contemplation. While significant progress has been made, past experiences teach us important lessons for the future, providing both insight for avoiding similar mistakes as well as suggestions as to how we may continue to advance. We should also appreciate the contributions made to our current care of the wounded by the many thoughtful and dedicated scientists and surgeons over

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