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arriving in the emergency department are acidotic and coagu- 5. Garner A, Crooks J, Lee A, Bishop R. Efficacy of prehospital
lopathic, a reflection of serious battle injury. Those casualties critical care teams for severe blunt head injury in the Austra-
being moved from smaller medical units to larger definitive lian setting. Injury. 2001;32:455–460. Epub 2001/07/31.
surgical units are comparatively well resuscitated with a nor- 6. Baxt WG, Moody P. The impact of a physician as part of the
malized acid-base status and coagulation, illustrating the ben- aeromedical prehospital team in patients with blunt trauma.
efit of early damage control resuscitation. Future wars may JAMA. 1987;257:3246–3250. Epub 1987/06/19.
have to address prolonged transportation times due to lack 7. Garner A, Rashford S, Lee A, Bartolacci R. Addition of
physicians to paramedic helicopter services decreases blunt
of immediately available advanced medical facilities (i.e., the trauma mortality. Aust N Z J Surg. 1999;69:697–701. Epub
“tyranny of distance”). Designing a plan for ongoing resusci- 1999/10/20.
tation during transit can mitigate the risk of prolonged trans- 8. Bartolacci RA, Munford BJ, Lee A, McDougall PA. Air medi-
portation and save lives in the next war. cal scene response to blunt trauma: effect on early survival.
Med J Aust. 1998;169:612–616. Epub 1999/01/15.
9. Garner AA. The role of physician staffing of helicopter emer-
Acknowledgments gency medical services in prehospital trauma response. Emerg
Med Australas. 2004;16:318–323. Epub 2004/07/31.
The authors wish to acknowledge the assistance of Robert 10. Davis PR, Rickards AC, Ollerton JE. Determining the compo-
Riffenburgh, Ph.D. at Naval Medical Centre San Diego for his sition and benefit of the pre-hospital medical response team
invaluable assistance with statistical analysis and Mr. Roland in the conflict setting. J R Army Med Corps. 2007;153:269–
Champagne for his assistance in the NMCSD Clinical Investi- 273. Epub 2008/07/16.
gations Department. The author(s) acknowledge Department 11. Apodaca A, Olson CM Jr, Bailey J, et al. Performance im-
of Defense Trauma Registry (DoDTR) for providing data for provement evaluation of forward aeromedical evacuation
this study and Ms. Susan West at the Institute for Surgical Re- platforms in Operation Enduring Freedom. J Trauma Acute
search, San Antonio, TX for facilitating access to the DoDTR Care Surg. 2013;75(Suppl 2):S157–S163. Epub 2013/08/02.
data. 12. Olson CM, Bailey J, Mabry R, et al. Forward aeromedical
evacuation: a brief history, lessons learned from the Global
War on Terror, and the way forward for US policy. J Trauma
Disclaimer Acute Care Surg. 2013;75(Suppl 2):S130–S136.
13. Lehmann R, Oh J, Killius S, et al. Interhospital patient trans-
The opinions or assertions contained herein are the private port by rotary wing aircraft in a combat environment: risks,
views of the authors and are not to be construed as official or adverse events, and process improvement. J Trauma. 2009;66
as reflecting the views of the Department of the Army or Navy, (Suppl):S31–S34; discussion S4–S6. Epub 2009/06/12.
the Department of Defense, the Ministry of Defense and the
Defense Medical Services of the United Kingdom.
CDR Tobin, Medical Corps, US Navy Reserve, is director,
Disclosures Trauma Anesthesiology, Keck Medicine at USC, Department
The authors report no conflicts of interest. The authors alone of Anesthesiology, Los Angeles, California.
are responsible for the content and writing of the manuscript.
Lt Col Nordmann, Royal Army Medical Corps, is a Senior
Lecturer in Military Anaesthesia, National Institute of Aca-
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