I will say subjectively that trauma medicine has changed since the advent of the Iraq/Afghanistan wars. The rule of combat have also changed for medical personnel in a combat zone. In the militarary I was a “provider” (that is a key word and tricky phrase in medicine) so I have had more certifications and initials behind my name than I can even remember. I worked under a MD’s license but I was “Independent Duty” so in civilian speak I was a PA without a license with a major in surgery and a minor in trauma and 10 -20 years of experience to back it up.
This is an aside but applicable in a historic sense. It used to be that Corpsmen were almost required to run out into the middle of a fire fight to pull some poor Bas$#@d that got hit to safety. Got a lot of Corpsmen dead. The new rule is to stop what is hurting the Marines/Soldiers etc. prior to running out there. That came from the SEAL’s/Ranger’s during the invasion of Panama in 1988, which I was a part of. Medic’s/Corpsmen are shooters too and more firepower is area dominance. In Iraq and Afghanistan it was the rule of war. Stop the bad guys from shooting and then attend to the wounded because you can’t help them if you are dead.
The biggest change in the last 10 - 20 years is the use of tourniquets. When I was a young OR Tech back in the late 80’s to the 90’s the “tourniquet time” for doing surgery on a limb was 6 hours and then you had to let it off for 30 min and then you got another 3 hours, then another 30 min of flow and you got 1.5 hours. At that point you were 10.5 hrs into surgery and needed to start asking questions.
IMHO now, you are NEVER more than 7 hours from surgical intervention in most places in the US (and in a combat zone elsewhere) YES there are exceptions and what if’s but in GENERAL. you are close.
So IMHO on an extremity wound a pressure dressing is nice but if it is uncontrolled strap a tourniquet on south of the nearest joint north of the wound and lock it down and evacuate.
ALL chest wounds suck.
All belly wounds will get infected if you live long enough.
All bleeding stops … eventually.
Understand how the body works and you will be heads and shoulders beyond the ABC crowd. The thing to know about the human body is “thicker” than most give it credit for and the vital parts are tucked in deep and are hard to get to.
If they are screaming: They have an airway and chances are they will live
If they are spurting: Tourniquet/Clamp
If they are bleeding: Pressure dressing
If they are sitting quietly holding their chest/belly taking “sips” of air … you better know what you are about…
If they are holding their hips groaning and trying not to move … pray that nothing is leaking because there are big pipes down there and hard to get to.
Kinda bold and brash but in the world of trauma medicine reality counts if you want to keep them alive. Ask anyone who has performed CPR for real if they remember the ribs breaking, the smell of blood being exhaled, it’s brutal.
GSW’s and Knife wounds all have their own particular problems but if you can keep your head clear you can get through it and save them.