Page 68 - Journal of Special Operations Medicine - Spring 2017

Pediatric Trauma
Management From an Austere Prospective

Joycelynn R. Gray, DO; Derek R. Linklater, MD;
James Johnston; Benjamin Donham, MD

ABSTRACT

Pediatric trauma represents a notable proportion of ca- deployed providers to consult with pediatric specialists,
sualties encountered by Combat medics, physician as- and deployment packets were augmented to contain
sistants, and physicians while in the deployed setting. pediatric-specific supplies. As part of predeployment
Most of these resuscitation teams receive limited pedi- training, a 1-week intensive pediatric trauma course was
atric-specific training and suffer subsequent emotional added to the Joint Forces Combat Trauma Management
stress due the perceived high-stakes nature of caring Course for physicians, physician assistants, and nurses.
1
for gravely wounded children. Even when children sur- Additionally, the number of deployed pediatric special-
vive long enough to arrive at combat support hospitals, ists was increased to compensate for the increased num-
there remain high risks for morbidity and mortality for ber of pediatric casualties.
many of them. There are numerous reports of the epi-
demiological characteristics of these pediatric patients, Despite these enhancements, there are few reports in the
the common mechanisms of injury, the hospital lengths literature that describe improvements in how medics are
of stay, and calls for pediatric-specific equipment and trained to care for pediatric patients. There is a strong
specialist presence in-theatre. There is scant literature, training emphasis on adult trauma, with most prehos-
however, on child-specific battlefield resuscitation and pital providers being exposed to advanced trauma life
training for initial providers, and we believe that, with support before deployment, but some Military Occupa-
appropriately tailored pediatric resuscitation education tional Specialties are known to receive greater degrees of
and training strategies, there is some potential for a re- pediatric training than others. 5
duction in the morbidity and mortality associated with
childhood combat injury. Pediatric Characteristics
The anatomic differences between children and adults
Keywords: pediatrics; combat injury; battlefield resuscitation need to be understood for optimal resuscitation to oc-
cur. The pediatric head makes up a larger proportion
of body surface area than the adult head; thus, there is
greater frequency of injury to this area. Data pulled from
Introduction
the Patient Administrative Systems and Biostatistics Ac-
During Operation Iraqi Freedom (OIF) and Afghani- tivity database and the Joint Theater Trauma Registry
stan/Operation Enduring Freedom (OEF), advances suggested that traumatic brain injuries are the second
in modern warfare resulted in an increased severity of most common injury pattern seen in admitted pediatric
injury and led to greater resource use, longer hospital patients during OEF and OIF, with only extremity and

stays, and a higher percentage of morbidity and mortal- torso wounds being more common. 2
ity. A retrospective study using data from US Combat
1,2
Support Hospitals (CSHs) was completed in 2009 and Additional factors that contribute to increased fre-
showed 7,505 pediatric admissions during this time; this quency of traumatic brain injury (TBI) include that the
comprised 5.8% of all admissions and represented a sig- bones of the pediatric neck are not fully developed, their
nificant pediatric workload. 1 bony connections are largely ligamentous, and there is
incomplete myelination of the brain, which increases
In response to this relatively unexpected influx of pe- susceptibility to shear forces and development of TBI.
diatric patients, the US military adapted its medical One potential benefit of the anatomic structure of the
infrastructure by providing specific pediatric resources infant skull, however, is that the cranial sutures are open
and education to deployed and deploying providers. A and, therefore, will tolerate higher intracranial pressures
3,4
video consultation network was developed that allowed during early stages of injury before herniation occurs.

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