Summary: Despite often being located near large cities, many Military Treatment Facilities abroad practice day-to-day as small hospitals with limited resources. When a polytrauma patient presented in critical condition to the urgent care of one such Military Treatment Facility, requiring emergent exploratory laparotomy, massive transfusion, and critical care for over 24 hours before medical air evacuation, the flexibility and creativity of providers at all levels were tested. Surgical staff created a makeshift wound vacuum after packing the abdomen, an endoscopy suite was transformed into an intensive care unit room, blood products were acquired from outside resources, and anesthesiology staff flexed into the roles of both intensive care nurses and providers. Checklists based on the Prolonged Field Care Casualty Card were created for hourly care endpoints, and schedules were made for provider-to-provider handoffs to prevent fatigue. This case details the prehospital management, initial emergent care, surgical intervention, damage control resuscitation, and prolonged care of this patient in a low-resourced environment before successful aeromedical evacuation. Lessons learned from this event can be used to assist implementation of a formal trauma protocol, improve medical readiness in the event of a mass casualty, and facilitate navigation of a semi-austere environment during extended care for critically ill patients.
Sutter et al. (Sun,) studied this question.