Field medicine

Field medicine encompasses, managing and performing medical services in the pre-hospital or non-hospital context, variously by emergency medical technicians under medical control or directly by advanced practitioners delivering advanced care outside the hospital. It has important synergies with emergency management dealing with multiple casualty and mass casualty incidents, as well as triage, but it is also concerned with single-victim situations. Much is concerned with trauma, but also with medical emergencies, especially dealing with large-scale poisoning, infections, or effects of weapons of mass destruction.

Field medicine is now a recognized subspecialty of emergency medicine. Within field medicine, there are also areas of interest that include wilderness medicine, battlefield medicine and disaster medicine.

Field medicine and trauma

While viewers of television emergency dramas often think of intravenous fluids as the most important paramedic intervention, aggressive fluid resuscitation, in trauma, can kill the patient. The standard of care for most trauma with blood loss is permissive hypotension, where just enough fluid is given to keep oxygen flow to the brain, but deliberately not restoring the systolic blood pressure to normal. A normal systolic blood pressure is high enough to dislodge the clots the body produced to stop bleeding, and start a new cycle of hemorrhage.

As one esteemed trauma surgeon put it, the treatment for trauma-induced hypotension is surgery, not fluids. While TV paramedics may fidget getting more intravenous flow, "scoop and run" is often the best possible treatment. Field personnel indeed should establish intravenous lines since veins may collapse, but not necessarily put any substantial volume through them until the first surgical facility is reached.

There are exceptions. Before extricating a victim of crush injury still under massive weight, specialized fluid and electrolyte loading is mandatory, or the victim may die within minutes after the weight is removed.

Battlefield medicine

The U.S. Army has introduced "combat lifesaver" program to support battlefield-oriented "scoop and run." While the original goal was to give the training and equipment to 10 percent of combat soldiers, there is strong pressure to make it 100 percent. While establishing IV access is not part of traditional first aid, it does make sense in many combat situations, when an evacuation helicopter can swoop in only after the enemy is suppressed -- and having that IV access makes sense at the first surgical facility, which will be reached in an indeterminate time.

Since the military can add treatments judged urgenrly needed without the same approval process required in civilian practice, certain drugs and procedures have appeared there first and are entering civilian practice.