نشریه بهداری رزمی دفاع مقدس و مقاومت
پیاپی 1 (بهار و تابستان 1397)

Experience with healthcare management under extreme conditions during the Iraq-imposed war are presented in this paper. Progress and success in the field of “Tactical Combat Casualty Care” included scientific and managerial measures as well as the dedication and active presence of diligent specialists and healthcare personnel during the war. Herein, a review of our experience with our trauma system during the war is presented.

Related and relevant literature on combat trauma management during the war are reviewed. Evidence-based experiences of experts and relevant managerial activists are documented.

Main strategies and basic management plans for our trauma system during 8 years of war is based on the following: 1. Systematic order and organization 2. Provision for the care of the injured and acquisition of all needed services, including the help of volunteers at all levels, from rescuers to nurses and specialist physicians 3. Integrating military and civil management of war injuries 4. Planning for control of immediate necessities and prediction to prepare for the near future, 5. Purposeful provision and distribution of needed equipment, drugs and supplies, 6. Obligation to adopt scientific and evidence-based guidelines on the latest scientific evidence. 7. Designing a comprehensive, responsive, and flexible trauma system with regard to different conditions (relief, transfer, emergency, triage, treatment, rehabilitation, follow-up). 8. Designing and educating basic duties and responsibilities of personnel at different levels 9. Regular and systematic monitoring and summing-up previous experience to re-design and improve the structure and available manpower 10. Conducting scientific conferences to present the experience gained

Healthcare management during the Iraq-imposed war showed the effectiveness of “Tactical Combat Casualty Care” and managerial measures and dedication and active presence of diligent specialists and healthcare personnel during the Iraq-Iran war.

Hemorrhagic shock is the leading cause of preventable death in warfare victims. Early resuscitation relies on prompt administration of suitable crystalloid and colloid solutions as well as whole blood and blood components. The purpose of this study was to present an effective guideline for use at emergency posts near the front lines to prevent the death of warfare victims in hemorrhagic shock.

In this short overview, our experience with fluid resuscitation in the management of hemorrhagic shock in wounded combatants during the Iraq-Iran war is presented.

Dry plasma, whole blood, and blood products to increase the plasma volume were used. Increasing intravascular volume targeting a systolic blood pressure of 90 mmHg was deemed optimal for maintaining perfusion of vital organs. Hypotensive resuscitation, damage control resuscitation via transfusion of whole blood, colloids, and limited volumes of crystalloids were effective in the management of shock.

Early resuscitation using whole blood primarily is recommended for the resuscitation of hypotension whenever possible. When blood products are not available colloids are preferred and are considered the next best option and are preferred over crystalloid solutions for the management of shock.

A case of complex facial trauma, from a high-velocity missile, involving the mandibular body and ramus and the dentoalveolar complex is presented. Devastating soft tissue injury of the lower face, lower jaw, lower lip, oral cavity, tongue, mouth, and upper neck placed a 30-years-old soldier in critical condition. After damage control resuscitation at a field hospital in Iraq, the patient was transported to a major hospital in Tehran. The patient recovered following complex reconstructive operations. Favorable healing and a satisfactory outcome were obtained after surgical treatment and rehabilitation.