军事医学正在为下一场冲突做准备

![](/media/202412//1733457408.0959547.png)

![](/media/202412//1733457408.1046526.png)军事医学正在为下一场冲突做准备

在伊拉克和阿富汗战争期间，军事医疗队在战场上有良好的位置，以支持“黄金时间”的反应——让受伤的战士从战场和

![](/media/202412//1733457408.1137834.png)在大约一小时内被送到一家全面的军事医院护理。

![](/media/202412//1733457408.1225212.png)[![](/media/202412//1733457408.1313696.png)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093934)

这是一个现实的目标，因为美国。军队拥有完全的空中优势，并维持着一流的国内创伤中心。

受伤的部队很少能远离他们所需要的救生护理。但下一个冲突可能会非常不同。

在五角大楼准备今天的军队与大型军事对手的对抗之际，军事卫生系统面临着为大规模分散行动提供救生支持的挑战。对于支持前线部队的医务人员来说尤其如此。

例如，如果一名海军陆战队员在太平洋的一个偏远岛屿上受伤，那么最高水平的护理可能是一项独立的任务

corpsman.疏散到更高层次的护理可能需要好几天的时间。对于军事医务人员来说，这种情况需要一种新的训练、新的设备和一种新的伤亡护理方法。

“我们担心未来的伤亡，因为这些距离[到

医院真是太棒了。”史黛西·沙克尔福德，局长[联合创伤系统](https://jts.amedd.army.mil/)在德克萨斯州圣安东尼奥的联合基地。

在未来，美国缺乏空中优势和远距离可能会阻止快速撤离。

沙克尔福德警告说，这些情况可能意味着黄金时间移交手术队。

黄金时刻是创伤患者进入的关键时间窗口

接受一系列挽救生命的干预措施

受伤和过渡到移交给一个手术团队。快速让患者通过这一过程对于挽救生命和改善结果至关重要。

如果受伤的战士无法得到这种护理，服务人员、特种作战人员和独立任务人员将“需要很多技能，比如使用止痛药、长期疼痛”

控制、气道管理和护理技能，比如换敷料——甚至是像滚动病人一样，”沙克尔福德说。

太平洋上的一场近距离的冲突可能会让受伤的作战人员在前线附近待上几天。”非洲也是同样的问题，我们将有陆路运输和水上疏散。”

“所有这些情况让我们认为，我们可能需要把病人保持在较低水平的护理中，你将让医生照顾病人几天——包括需要手术的病人。”不能去找外科医生意味着必须在较低的护理水平下长期稳定这些病人，”她解释说。

JTS是国防卫生局的一部分，它的任务是改进

战斗伤亡的结果从战略水平到

通过证据驱动的性能改进而产生的冲突场景。在DHA的作用下，JTS还扩展了数据捕获和

收集其国防部创伤登记处的能力，并增加了特殊伤害登记处。

[![](/media/202412//1733457408.144786.jpeg)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093942)

**为下一场比赛做准备**

在未来潜在的近同伴冲突发生之前，医务人员的培训正在发生巨大的变化。

为了应对这一挑战，医疗人员的技能从培训的一开始就开始升级，整个DHA正在开发或调整策略和策略，以反映新的现实。

美国陆军上校说：“我们预计，通过大规模的作战行动，每个医疗保健梯队都需要做好更好的准备，用有限的资源治疗大量伤亡人员。”约翰尼保罗，

![](/media/202412//1733457408.1545715.png)[陆军战斗医疗专家训练系主任](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction)

[在圣安东尼奥的项目](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction)[医学教育和培训校园](https://www.metc.mil/)[在](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction)德克萨斯州休斯顿山姆堡。

例如，保罗说，你可能通过向军人血液计划捐赠或“行走的血”来获得全血输血

“对抗可以通过直接输血捐献新鲜血液的伙伴”。

医护人员现在正在接受更新的、更高级的培训，并向他们灌输潜在的救生技能和方法。保罗说，包括：

使用全血药。

经营一个能行走的血库。

沙痂远程医疗。

沙痂膀胱导尿。

Subark通风机管理。

沙痂气道管理。

长期的伤亡监测，包括营养和护理。

**陆军医疗训练**

为了满足这些需求，战斗医疗专家项目已经有

在其72小时战斗现场训练演习中介绍了延迟疏散护理组件。

其目标是揭露军队的医疗点医疗人员

![](/media/202412//1733457408.1643384.png)68名威士忌战斗医疗专家-到延长的原则[田间管理68W被分配到陆军医疗中心](https://medcoe.army.mil/)

[在圣安东尼奥联合基地的卓越表现。](https://medcoe.army.mil/)

第一批有275名参加了延长护理疗程的医生

2021年8月毕业，其医生接受了在前线输血的培训。这是医护人员传统上只有在职业生涯后期才会学习的技能。

保罗说，增加长期的伤亡护理培训使一个

对学生在课堂上需要学习的高级知识和技能集有不同的关注。这与之前的战斗医疗课程相比是一个很大的变化，之前的课程主要是治疗受伤时的伤员，假设病人很快就会撤离。

一种针对所有医疗人员的新的训练计划，被称为战术战斗

伤亡护理公司，于2021年12月15日开始运作。课程包括火力下的护理训练、战术野战护理和战术疏散护理。

TCCC的指导方针是所有服务分支的前线战斗护理的蓝图，并不断更新

临床实践。

长期伤亡护理的课程包括气道管理、急性创伤性伤口护理、镇痛和镇静管理、烧伤伤口和挤压伤。

一些TCCC课程是提供给所有服务中的急救人员，以防没有立即可用的医疗人员或医护人员。

“这种额外的培训将导致更高层次的紧急情况

针对毕业生的医疗技术人员认证，”保罗说。“[That]将直接转化为更先进的战斗医疗证书

医务人员。”

目前，医疗人员正在基本的国家认证注册。新的课程将把这个认证升级到

高级电磁治疗。“这些认证都是国家认可的，”保罗指出。

[![](/media/202412//1733457408.1759648.jpeg)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093941)

**更先进的战场医疗训练**

海军和海军陆战队也在为长期的伤亡护理和可能需要健康的危机情况做准备

海军陆战队员将在战场上献血，以帮助治疗受伤者。

在战场上，受过救生训练的海军陆战队员是在有骑兵之前阻止可预防的死亡的重要资产。

然而，在CLS中学到的技能不仅与战场有关。CLS的原理可以应用于一系列的医学领域

一名海军陆战队官员说，这是一种紧急情况。清除气道，

减轻失血和夹板治疗潜在的致命骨折是CLS期间教授的一些技能。

中将。空军卫生局局长罗伯特·米勒最近在参议院的拨款听证会上作证，他强调了今天为明天的战场做好准备的重要性。

米勒说：“未来的冲突可能会导致医疗人员需要在已部署的环境中关押和治疗病人的时间比过去更长。”我们正在积极评估我们的团队如何保持敏捷，并利用技术提供值得信赖的护理……随时时间、任何地点。”

![](/media/202412//1733457423.2447295.png)

![](/media/202412//1733457423.2551904.png)Military Medicine Is Preparing for the Next Conflict

During the wars in Iraq and Afghanistan, military medical teams were well positioned on the battlefield to support the "golden hour" response — the ability to get wounded warfighters off the battlefield and

![](/media/202412//1733457423.2661881.png)delivered to the care of a full-scale military hospital within about an hour.

![](/media/202412//1733457423.2750077.png)[![](/media/202412//1733457423.283454.png)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093934)

And that was a realistic goal, given that the U.S. military had total air superiority and maintained top-tier, in-country trauma centers.

Wounded troops were rarely far from the life-saving care they needed. But the next conflict might be very different.

As the Pentagon prepares today's force for a near-peer fight against a large military adversary, the Military Health System is challenged to provide life-saving support for large-scale and dispersed operations. That’s especially true for the medics supporting troops on the front lines.

For example, if a Marine was wounded on a remote island in the Pacific, the highest level of care available might be an independent duty

corpsman. Evacuation to a higher level of care might take several days. For military medics, this scenario requires a new kind of training, new equipment and a new approach to casualty care.

"We're worried about future casualties because those distances [to

hospitals] are so great," said Air Force Col. Stacy Shackelford, chief of the [Joint Trauma System](https://jts.amedd.army.mil/) in Joint Base San Antonio, Texas.

In the future, a lack of U.S. air superiority and vast distances could prohibit quick evacuations.

Those conditions likely mean that the golden-hour handoff to a surgical team will not be possible, Shackelford warned.

The golden hour is the critical time window for trauma patients to

receive a series of life-saving interventions — starting at the point of

injury and transitioning to handoff to a surgical team. Moving patients quickly through that process is essential to saving lives and improving outcomes.

If wounded warriors are unable to get that care, service medics, special operations medics and independent duty corpsmen will "need a lot of skills, such as in administering pain medications, long-term pain

control, airway management, and nursing skills like changing dressings — even things like rolling the patient," Shackelford said.

A near-peer conflict in the Pacific could leave injured warfighters near frontlines for days. "Africa would be the same type of issue, when we would have overland transport versus water evacuation," Shackelford said.

"All of those situations make us think that we may need to hold patients at lower levels of care, where you're going to have medics taking care of patients for days — including patients that need surgery. Not being able to get to a surgeon means having to stabilize those patients for longer periods of time at lower levels of care," she explained.

The mission of JTS, part of Defense Health Agency, is to improve

outcomes for combat casualties from the strategic level down to the

scene of conflict through evidence-driven performance improvement. Under the DHA,the JTS also has expanded the data capture and

collection capabilities of its Defense Department Trauma Registry with the addition of special injury registries.

[![](/media/202412//1733457423.298429.jpeg)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093942)

**Preparing for the Next Fight**

Medics'training is changing dramatically in advance of future potential near-peer conflicts.

To meet this challenge, medics'skills are being upgraded from the very start of their training, and the entire DHA is developing or reworking tactics and stratagems to reflect the new reality.

"We expect that with large-scale combat operations, every echelon of medical care will need to be better prepared to treat large numbers of casualties with limited resources," said Army Col. Johnny Paul,

![](/media/202412//1733457423.3078704.png)[department chair for the Army Combat Medic Specialist Training](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction)

[Program at the San Antonio](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction) [Medical Education and Training Campus](https://www.metc.mil/) [at](https://www.metc.mil/Academics/Programs/Combat-Medic-Specialist-Training-Program/#:~:text=The%20Combat%20Medic%20Specialist%20Training,designed%20with%20team%2Dpaced%20instruction) Fort Sam Houston, Texas.

For example,Paul said, you may get whole blood transfusions through donations to the Armed Services Blood Program or from "walking blood

banks," combat buddies who can donate fresh blood via direct transfusion.

Medics are now receiving newer, more advanced training, instilling in them potential life-saving skills and methods. Paul said that includes:

• Use of whole blood.

• Operating a walking blood bank.

• Telemedicine.

• Bladder catheterization.

• Ventilator management.

• Airway management.

• Prolonged casualty monitoring to include nutrition and nursing care.

**Army Medic Training**

To address these needs, the Combat Medic Specialist Program has

developed an Introduction to Delayed Evacuation Care component to its capstone 72-hour combat field-training exercise.

The goal is to expose the Army's point-of-care medical personnel — the

![](/media/202412//1733457423.3187828.png)68 Whiskey Combat Medic Specialists — to the principles of prolonged [field care. The 68W are assigned to the Army Medical Center of](https://medcoe.army.mil/)

[Excellence at Joint Base-San Antonio.](https://medcoe.army.mil/)

The first class of 275 medics who took the prolonged care course

graduated in August 2021, and its medics are trained to transfuse blood on the frontlines. That is a skill that medics have traditionally learned only later in their careers.

Paul said the addition of prolonged casualty-care training puts a

different focus on the advanced knowledge and skill sets students will need to learn in class. That's a big change from previous combat medic courses, which focused on the treatment of casualties at the point of injury with the assumption that a patient would soon be evacuated.

A new training program for all medics, known as Tactical Combat

Casualty Care, became operational on Dec. 15, 2021.The curriculum includes training for care under fire, tactical field Care and tactical evacuation care.

TCCC guidelines are the blueprint for combat care at the frontlines for all branches of service and they are updated continually with best

clinical practices.

The courses for prolonged casualty care include airway management, acute traumatic wound care, analgesia and sedation management, burn wounds, and crush injuries.

Some of the TCCC curriculum is given to first responders in all services in case there is no medic or corpsmen immediately available.

"This additional training will result in a higher level [Emergency

Medical Technician] certification for graduates," Paul said. "[That] will directly translate to more advanced medical credentials for combat

medics."

Currently, medics are on a national certification registry at the basic EMT level. The new curriculum will upgrade that certification to

Advanced EMT. "These certifications are nationally recognized," Paul noted.

[![](/media/202412//1733457423.3296788.jpeg)](https://www.defense.gov/News/News-Stories/Article/Article/3062283/military-medicine-is-preparing-for-the-next-conflict/#pop6093941)

**More Advanced Battlefield Medical Training**

The Navy and Marine Corps are also preparing corpsmen for prolonged casualty care and for crisis situations that might require healthy

Marines to donate blood on the battlefield to help treat injuries.

On the battlefield, combat life saver-trained Marines are an essential asset in stopping preventable deaths before a corpsman is available.

However, the skills learned in CLS aren't only relevant to the battlefield. The principles of CLS can be applied across a range of medical

emergencies, a Marine Corps official said. Clearing an airway,

mitigating blood loss and splinting a potentially fatal bone fracture are some of the skills taught during CLS.

Lt. Gen. Robert Miller, Air Force Surgeon General, testified recently at a Senate appropriations hearing, where he emphasized the importance of preparing today for tomorrow's battlespace.

"Future conflicts may see medics needing to hold and treat patients in deployed settings for longer periods than in the past," said Miller. "We are actively evaluating how our teams can remain agile and leverage technology to provide trusted care…anytime, anywhere."