Consensus statement on decision making in junctional trauma care.

Area of Science:

• Military surgery
• Trauma care
• Surgical resuscitation

Background:

• Improvised explosive devices (IEDs) are a major cause of fatalities in Afghanistan.
• Short evacuation timelines challenge timely hemorrhage control and initial wound surgery, often limiting care to 75 minutes.

Purpose of the Study:

• To provide clear, didactic statements offering advice to consultant teams managing trauma casualties.
• To emphasize the critical role of surgical intervention in managing bleeding.

Main Methods:

• Review of current practices in managing severely injured patients in Afghanistan.
• Development of 25 didactic statements by the Lower Limb and Torso Trauma Working Groups.
• Focus on 'right turn resuscitation', damage control surgery, and multidisciplinary team operating.

Main Results:

• Multiple team operating involving up to seven surgeons and three anesthetists is the norm for IED casualties.
• Adjuncts like pressure, bandaging, hemostatic dressings, and tourniquets are available but not definitive.
• Formal surgical control is the definitive method for managing hemorrhage.

Conclusions:

• Bleeding is fundamentally a surgical problem requiring definitive control.
• Early proximal control of bleeding above the zone of injury is mandatory in all cases.
• Multidisciplinary surgical teams are essential for managing complex trauma.