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Activity title

Improving Anesthesia and Sedation through the Battlefield

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Human Factors and Medicine

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Awaiting Publication

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anesthesiology, Combat casualty care, en route care, intensive care


More than 70000 NATO soldiers have been wounded since the beginning of OEF and OIF. All of them underwent at least one anesthesia or procedural sedation. However, despite their frequency in modern war settings, anesthesia and procedural sedation do not currently benefit from standardized NATO guidelines. This could be a significant concern as anesthesia providers have various degrees and qualifications throughout NATO contributing forces. Combat casualty care is very different from civilian trauma care, due to a very different pathogeny of the lesions. Combat casualties are indeed characterized by a growing proportion of explosive related injuries such as multiple lesions with open or blunt trauma, blast, or burn injuries. In the same way, performing anesthesia and sedation differs from civilian practice and must be adapted to the level of care available on the battlefield: a determinate procedure cannot be performed in the same way according to the capabilities (drugs, monitoring, providers) of the structure (role 1, 2 or 3 MTF). Anesthesia and sedation for combat casualties have a wide range of application in military medical services and need a comprehensive and rational approach. Furthermore, there is a growing body of evidence for the usefulness of well-performed anesthesia/analgesia/sedation procedures to reduce the incidence of post-traumatic stress disorder among wounded soldiers.


- To identify requirements for anesthesia and sedation on the field - To propose evidence-based consensus NATO guidelines for the management of anesthetic and sedation procedures through the battlefield.


1. Data collection on current anesthetic concepts for the main clinical situations of combat casualties (i.e. hemorrhagic shock, blast injury, burn injury, brain injury, thoracic injury etc.) and establish common clinical guidelines for their management. 2. Creation of common clinical guidelines for pain management on the battlefield (regarding medication but also regional anaesthesia). 3. Creation of common minimal requirements regarding anaesthetics informations in medical records. 4. Creation of common clinical guidelines for the management of difficult airway on deployment, from Role 1 to en-route care. 5. Creation of common clinical guidelines for anaesthesia and en-route care. 6. Creation of common clinical guidelines for fluid therapy or damage control resuscitation on the battlefield. 7. Creation of common clinical guidelines for sedation throughout the battlefield.

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