In medicine, triage is a process by which care providers such as medical professionals and those with first aid knowledge determine the order of priority for providing treatment to injured individuals and/or inform the rationing of limited supplies so that they go to those who can most benefit from it. Triage is usually relied upon when there are more injured individuals than available care providers, or when there are more injured individuals than supplies to treat them.
Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. They may also be known as a first aid squad, FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.
Medical evacuation, often shortened to medevac or medivac, is the timely and efficient movement and en route care provided by medical personnel to wounded being evacuated from a battlefield, to injured patients being evacuated from the scene of an accident to receiving medical facilities, or to patients at a rural hospital requiring urgent care at a better-equipped facility using medically equipped air ambulances, helicopters and other means of emergency transport including ground ambulance and maritime transfers
Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.
Mobile Army Surgical Hospitals (MASH) were U.S. Army field hospital units conceptualized in 1946 as replacements for the obsolete World War II-era Auxiliary Surgical Group hospital units. MASH units were in operation from the Korean War to the Gulf War before being phased out in the early 2000s. Each MASH unit had 60 beds, as well as surgical, nursing, and other enlisted and officer staff available at all times. MASH units filled a vital role in military medicine by providing support to army units upwards of 10,000 to 20,000 soldiers. These units had a low mortality rate compared to others, as the transportation time to hospitals was shorter, resulting in fewer patients dying within the "Golden Hour", the first hour after an injury is first sustained, which is referred to in trauma as the "most important hour". The U.S. Army deactivated the last MASH unit on February 16, 2006, and the successors to Mobile Army Surgical Hospitals are combat support hospitals.
Casualty evacuation, also known as CASEVAC or by the callsign Dustoff or colloquially Dust Off, is a military term for the emergency patient evacuation of casualties from a combat zone. Casevac can be done by both ground and air. "DUSTOFF" is the callsign specific to U.S. Army Air Ambulance units. CASEVACs by air today are almost exclusively done by helicopter, a practice begun on a small scale toward the end of World War II; before that, STOL aircraft, such as the Fieseler Fi 156 or Piper J-3 were used.
Aeromedical evacuation (AE) usually refers to the use of military transport aircraft to carry wounded personnel.
A flight paramedic is a paramedic who provides care to sick and injured patients in an aeromedical environment. Typically a flight paramedic works with a registered nurse, physician, respiratory therapist, or another paramedic. Flight paramedics must have an advanced medical knowledge along with years of clinical experience. Flight paramedics in the United States usually hold certifications such as the FP-C or the CCP-C, while in countries like the United Kingdom, they are typically required to hold a postgraduate certificate in critical care as a minimum, with many holding a master's degree in advanced practice or aeromedical critical care.
A flight nurse is a registered nurse who specialises in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft or jet aircraft. On board a rescue aircraft you would find a flight nurse accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more commonly seen in pediatric and neonatal transport teams. A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather. Some patients may experience exacerbation because of factors related to the cabin environment including hypoxia, limited mobility, gas expansion, and risk of injury related to turbulence and resources with definitive care are limited. Aeromedical evacuation crews coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients with trauma and mental health illnesses.
No. 4626 Aeromedical Evacuation Squadron is a unit of the British Royal Auxiliary Air Force, which manages, maintains and trains its personnel for operational readiness in support of RAF requirements for Aeromedical Evacuation and Pre-Hospital Emergency Care, Primary Healthcare (PHC) and individual augmentees to other military healthcare capabilities, in times of conflict or crisis.
The Emergency Medical Retrieval Service (EMRS) is part of ScotSTAR retrieval service. The EMRS provides aeromedical critical care retrieval and pre-hospital care to people in Scotland in the form of two retrieval teams. The service provides patients in remote and rural areas with rapid access to the skills of a consultant or senior doctor in emergency medicine, intensive care medicine or anaesthesia, and facilitates transfers to larger, better equipped urban hospitals. The EMRS functions supplementary to the regular Scottish Ambulance Service Air Ambulance service. Unlike air ambulance services in other parts of the UK, EMRS has no dedicated aircraft but both EMRS North and West are funded by the Scottish Government. The EMRS has occasionally featured on the Channel 5 documentary series Highland Emergency, which charts the work of rescue services in the Scottish Highlands.
A mass casualty incident describes an incident in which emergency medical services resources, such as personnel and equipment, are overwhelmed by the number and severity of casualties. For example, an incident where a two-person crew is responding to a motor vehicle collision with three severely injured people could be considered a mass casualty incident. The general public more commonly recognizes events such as building collapses, train and bus collisions, plane crashes, earthquakes and other large-scale emergencies as mass casualty incidents. Events such as the Oklahoma City bombing in 1995, the September 11 attacks in 2001, and the Boston Marathon bombing in 2013 are well-publicized examples of mass casualty incidents. The most common types of MCIs are generally caused by terrorism, mass-transportation accidents, fires or natural disasters. A multiple casualty incident is one in which there are multiple casualties. The key difference from a mass casualty incident is that in a multiple casualty incident the resources available are sufficient to manage the needs of the victims. The issue of resource availability is therefore critical to the understanding of these concepts. One crosses over from a multiple to a mass casualty incident when resources are exceeded and the systems are overwhelmed.
CareFlight is an air medical service headquartered in Westmead, New South Wales, Australia.
The 28th Combat Support Hospital was a Combat Support Hospital of the United States Army. It was first constituted in 1943 and served in China during World War II. During the Gulf War in 1990, it was the first Army hospital unit established and deployed into Iraq with combat forces of the XVIII Airborne Corps. More recently it has been involved in relief operations following natural disasters and has undertaken several recent deployments to Iraq. The unit fell under the command of the 44th Medical Brigade and was based at Fort Bragg, North Carolina.
Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation and rescue operations.
The Aeromedical Isolation Team of the US Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, Maryland was a military rapid response team with worldwide airlift capability designed to safely evacuate and manage contagious patients under high-level (BSL-4) bio-containment conditions. Created in 1978, during its final years the AIT was one of MEDCOM’s Special Medical Augmentation Response Teams comprising a portable containment laboratory along with its transit isolators for patient transport. Contingency missions included bioterrorism scenarios as well as the extraction of scientists with exotic infections from remote sites in foreign countries. The AIT trained continuously and was often put on alert status, but only deployed for “real world” missions four times. The AIT was decommissioned in 2010 and its mission was assumed by one of the US Air Force’s Critical Care Air Transport Teams (CCATTs).
The 274th Forward Surgical Team (Airborne)—part of the 274th Forward Resuscitative and Surgical Detachment (Airborne)—is an airborne forward surgical team of the United States Army providing Level II care far forward on the battlefield. It was first constituted in 1944 and served in Europe during World War II. More recently it has been involved in relief operations following natural disasters and has undertaken several recent deployments to Iraq and Afghanistan. The 274th Forward Surgical Team was part of both the initial entry forces of Operation Enduring Freedom in 2001 and Operation Iraqi Freedom in 2003. Currently the unit falls under the command of the 28th Combat Support Hospital and is based at Fort Bragg, North Carolina.
Scottish Specialist Transport and Retrieval (ScotSTAR) is the Scottish national service for adult, paediatric and neonatal patients. The service is run by the Scottish Ambulance Service and brings together NHS Scotland's three specialist transport and retrieval services: the Scottish Neonatal Transport Service (SNTS), the Transport of Critically Ill and Injured Children Service and the Emergency Medical Retrieval Service (EMRS). The service operates from a bespoke base near Glasgow and expects to be able to cater for 2,200 critically ill children and adults every year.
The United States Air Force School of Aerospace Medicine (USAFSAM) is the United States Air Force (USAF) organization focused on education, research, and operational consultation in aerospace and operational medicine. USAFSAM was founded in 1918 to conduct research into the medical and physiologic domains related to human flight, and as a school for medical officers trained to support military aviation operations, later coined as flight surgeons. The school supported early military aviation from World War I through the evolution of aviation and into the modern era. USAFSAM conducted medical research and provided medical support for the initial US space operations beginning in 1947 through the establishment of NASA in 1958. After the creation of NASA, USAFSAM continued to actively support civilian and military manned space missions through clinical and physiologic research. USAFSAM is one of the oldest continually operating school for flight surgeons and other operational medical personnel of its kind in the world. USAFSAM is located in Dayton, Ohio at Wright-Patterson Air Force Base, and is part of the 711th Human Performance Wing and the Air Force Research Laboratory (AFRL).
Tactical Combat Casualty Care are the United States military guidelines for trauma life support in prehospital combat medicine, designed to reduce preventable deaths while maintaining operation success. The TCCC guidelines are routinely updated and published by the Committee on Tactical Combat Casualty Care (CoTCCC), which is part of the Defense Committees on Trauma (DCoT) division of the Defense Health Agency (DHA). TCCC was designed in the 1990s for the Special Operations Command medical community. Originally a joint Naval Special Warfare Command and Special Operations Medical Research & Development initiative, CoTCCC developed combat-appropriate and evidence-based trauma care based on injury patterns of previous conflicts. The original TCCC corpus was published in a Military Medicine supplement in 1996. TCCC has since become a Department of Defense (DoD) course, conducted by National Association of Emergency Medical Technicians.
