Aeromedical Evacuation AE. Air Transportable Hospital. Air Force Theater Hospitalization. Critical Care Air Transport Team. Ancillary Personnel Augmentation Team.
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Yahoo groups adult listings us. Introduction
The development of modern intensive care units ICUs has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure.
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- Increasing missions into minimally supported or previously unsupported areas of the globe may often necessitate risk mitigation and a strategy to minimize the risk.
- Main Content Providing the best medical care in the worst of times During disasters and emergencies — and even during large-scale national security events - the need for medical care can quickly overwhelm the system.
Aeromedical Evacuation AE. Air Transportable Hospital. Air Force Theater Hospitalization. Critical Care Air Transport Team. Ancillary Personnel Augmentation Team. Biological Augmentation Team. Biological Augmentation Team Allowance Standard. BAT Allowance Standard. Biomedical Equipment Repair Augmentation Team. Transportable Blood Transshipment Center. Command and Control Augmentation Team.
Endodontic Augmentation Team. ENT Augmentation Team. Ophthalmology Augmentation Team. Air Transportable Dental Clinic. Mental Health Augmentation Team. Mental Health Rapid Response Team.
Gynecological Treatment Team. Theater Epidemiology Team. Infectious Disease Module. Computed Tomography Scan Team. Infectious Disease Augmentation Team. Medical Materiel Manpower Team. Oral Surgery Augmentation Team.
Neurosurgical Augmentation Team. Pediatric Dentistry Augmentation Team. Pediatric Module. Periodontics Augmentation Team. Patient Movement Element. Urology Team. Primary Care Team. Radiology Augmentation Team. Hospital Surgical Expansion Package.
Medical Systems Augmentation Team. C
During Operation Enduring Freedom, U. In a disease outbreak, they may provide mass prophylaxis. They have already started developing machine learning-based predictive tools for diagnosis and prognosis of Acute Respiratory Distress Syndrome, or wet lung, a fast-moving and often fatal disease that occurs in critically ill patients. The views expressed are the personal views of the writers and do not necessarily represent the views of DoD or its Components. USSOCOM medical enterprise support to educate and familiarize the SOF mission to general purpose force surgical teams could include expanding country agreements, cultural training, standardized tactical skills, weapons familiarization, expectation management for skill degradation and familiarity to Joint, Global Health Engagement, Medical Training and Foreign Internal Defense FID opportunities. United States biological defense program. According to Joint U.
Critical care augmentation team. Chen-Nee Chuah’s team receives $4.4 million to bring AI and smart devices to healthcare
The development of modern intensive care units ICUs has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure. Natural disasters and military operations are two common situations that can create critically ill patients in an environment that is austere or has been rendered austere. This has driven the development of two related strategies to care for these casualties. Portable ICU capability can be rapidly established in the area of need, providing relatively advanced capability but limited capacity and sustainability.
The other strategy is to rapidly evacuate critically ill and injured patients following their initial stabilization. This permits medical personnel in the austere location to focus resources on a larger number of less critical patients. This strategy requires careful planning to overcome the constraints of the transport environment. The optimal strategy has not been determined, but a combination of these two approaches has been used in recent disasters and military operations and is promising.
The critical care delivered in an austere setting must be integrated with a long-term plan to provide follow-on care. The capability to provide medical care to critically ill patients has evolved considerably over the last half-century.
Hospitals developed intensive care units ICUs where special expertise and equipment could be used for unstable patients. Recent studies have elucidated the significant impact on patient outcomes that result from ICU physician staffing models [ 1 ]. Data suggesting that the intensity of ICU staffing alone can affect a change in overall hospital morality and length of stay for critically ill populations lend credence to the importance of adequate and aggressive ICU care.
As the field of critical care develops, it has become clear not only that ICUs are effective tools for resuscitation and stabilization of the critically ill, but that the skill with which the treatments are initiated there have lasting effects on the overall hospital course of the patient. A modern ICU represents a complex assembly of skilled personnel and physical infrastructure.
This infrastructure must include space to support patients and staff; temperature control; secure oxygen, electricity, water, and vacuum sources; medical supplies; pharmaceutical agents; and equipment [ 2 ]. ICUs also have ready access to surgical, radiographic, transfusion, and laboratory capabilities.
The level of care available in an ICU establishes a standard of care for unstable patients. Natural disasters and human conflict are two common occurrences leading caregivers to develop the capability to extend this standard of care into austere environments.
Natural disasters may strike population centers with advanced medical care, simultaneously producing casualties and incapacitating even a well-developed health care system [ 3 , 4 ]. Disasters also can strike remote regions with little pre-existing medical infrastructure. The sudden increase in the number of critically ill patients following a disaster can be overwhelming, and caregivers in this setting face major challenges in establishing a critical care capability [ 5 ].
Human conflict also has the potential to create casualties and destroy or incapacitate a health care system and often adds security to the caregiver's concerns. In response to these challenges, two major strategies have emerged: portable critical care and critical care transport. A working group of the Society of Critical Care Medicine has considered the situation in which an infrastructure is intact but overwhelming numbers of casualties occur, such as in a bioterrorist attack.
This group has developed the concept of augmenting critical care in place [ 6 ]. There has been significant development in austere critical care but, to date, little structured scientific study. This review examines what has been learned about provision of critical care in such austere environments. The medical response to recent disasters illustrates how critical care was successfully provided within the disaster area.
A major earthquake struck western Turkey in August , resulting in thousands of casualties and major damage to the region's medical infrastructure. The Israeli Defense Forces deployed a field hospital to the city of Adapazari, where 2, people died and 5, were wounded [ 7 ]. This hospital included a bed ICU in which they managed 63 patients.
The ICU was staffed with 3 physicians, 3 nurses, and 5 paramedics. Over the course of 2 weeks, this team managed a range of medical, trauma, and post-surgical patients. To enhance their sustainability, they successfully integrated with the local medical system to augment their equipment and supplies.
One of the major functions cited in the report was preparation of patients for transfer to unaffected areas. This resulted in closure or major curtailment of services in nine hospitals with resultant compromise in emergency and critical care in the city.
This facility was operational with 3. In December , an earthquake struck Bam, Iran, causing many thousands of casualties and disabling the city's medical system. There was a brisk international response, with many nations deploying field hospitals to assist. The authors faced a range of casualties from those suffering acute trauma to delayed complications such as soft tissue infection and compartment syndrome as well as exacerbation of chronic illness. This report describes the hardship from operating continuously with little infrastructure and emphasizes that medical capability is ineffective without non-medical infrastructure such as communication, safety, sanitation, and security.
They emphasize the critical role of casualty evacuation outside of the disaster area. Field hospitals have been developed by military medical services, civilian governments, and non-governmental organizations to serve the population affected by war, unrest, or disaster. From a critical care perspective, these hospitals must prepare not only to address trauma or direct effects of a disaster, but also to treat pre-existing disease and decompensation of patients with comorbid conditions.
The surgical and critical care capabilities of a medical center cannot be duplicated in a matter of hours or days, but portable, rapidly deployable teams have been developed to provide the major components of resuscitation and stabilization.
Considering the design characteristics of an ideal fixed ICU, a deployable ICU can approach this with some conscious compromises. In general, enhancing capability, capacity, or sustainability increases cost and complexity and decreases portability. The capability that can be developed with prior planning and investment stands in contrast to the situation that confronts health care workers forced to improvise after disaster destroys their resources. Between disasters, limited resources and pressing daily needs force hospitals to de-emphasize disaster preparedness [ 5 ].
In September , Hurricane Katrina devastated the US Gulf Coast, basic infrastructure was destroyed, and the extensive health care system across this region was severely curtailed. Disaster response planners established Louis Armstrong International Airport as a primary evacuation site for the city of New Orleans. Initial responders were overwhelmed by the high number of patients and lack of basic infrastructure such as potable water, medical supplies, and communications with command authorities.
A primitive field hospital with ICU capabilities was established at the airport. These providers were hampered by an immediate lack of ICU resources such as ventilators, oxygen, and respiratory therapists.
Additionally, there was no mechanism for resupply or patient evacuation [ 10 ]. His team primarily managed critical illness resulting from destruction of the existing medical infrastructure rather than direct storm damage.
Their evacuees included patients with recent liver-kidney transplant, acute upper gastrointestinal bleeding in a setting of cirrhosis, critical hyperkalemia in dialysis-dependent renal failure, and delirium tremens in an alcoholic. As would be expected in an overwhelmed medical system, these patients were consuming the attention of their caregivers to the exclusion of non-critical patients.
The lack of a stockpile of simple portable mechanical ventilators meant that some patients in respiratory failure were bag-ventilated by hand for many hours, completely occupying a caregiver each. An easily overlooked complication of critical care in austere locations is infection. The challenge of maintaining infection control in an improvised ICU includes control of environmental contamination from the exterior as well as the risk of cross-contamination between patients in crowded conditions and when basic supplies are limited.
In addition, organisms particular to that environment may be encountered. Tsunami victims evacuated from Southeast Asia in exhibited highly resistant strains of less common organisms. The difficult-to-treat Acinetobacter , Pseudomonas , and Stenotrophomonas cultured from the evacuees not only placed them at increased risk, but also exposed native patients to the organisms once they were introduced into the existing health care system [ 11 ].
Among the casualties in Iraq, locally acquired Acinetobacter baumannii infection has been a major challenge [ 12 ]. A recent report indicates that factors of austere environment and native organisms can be successfully managed. In a small series, the authors report on their experience with definitive repair of open facial fractures in critically injured patients while in a tent hospital, without causing serious wound infections [ 13 ].
During the Cold War, the US military prepared for massive engagement in a predictable location and medical capability was developed accordingly. Post-Cold War, the US military has been heavily employed in a spectrum of operations from disaster relief, humanitarian, and peacekeeping operations through war.
Medical capability has kept pace through development of deployable field hospital systems. The modest size makes this team readily deployable. This unit is highly capable, providing primary care and public health support, general and orthopedic surgery, and a critical care resuscitation and holding capability, although capacity and unsupported sustainability are limited. As a given operation matures and the requirement for capacity increases, modules can be added to create a or bed hospital with an ICU capability.
Specialty modules, including ICU, can be added to this backbone depending on mission requirements. The hospital modules can also be linked to create a theater hospital, which is essentially a field medical center. The EMEDS is housed in a tent system with climate control that allows it to function across a range of temperature extremes. This capability has been used effectively to care for rescue workers at the World Trade Center following the attack on September 11, ; victims of a nightclub fire in Rhode Island; and for earthquake victims in Iran [ 7 , 14 ].
It is the primary evacuation hub for all injured coalition casualties in Iraq. This hospital currently functions on the model of a US Level I trauma center and provides continuous coverage by trauma surgeons, critical care physicians, and other surgical subspecialists. It is currently comprised of 18 ICU beds, 10 emergency room bays, 2 computed tomography scanners, and 4 surgical suites running up to 8 operating tables. The major limitations of these systems are sustainability and capacity.
A central consideration in establishing this capability is the ability of the local heath care system to absorb the follow-on care initiated at these facilities. Planning for this follow-on care needs to incorporate the local medical system and possibly non-governmental organizations that provide and develop medical capability in austere locations.
As local follow-on care is being developed, austere critical care must include a robust mechanism for patient transport to locations where they can be absorbed and where the resuscitative measures initiated in the austere environment can be continued. Transport of unstable patients away from an austere location relieves a load on the local resources. However, moving an unstable patient exposes that patient to risk.
Within a hospital, this risk is weighed each time an ICU patient is moved for a diagnostic or therapeutic procedure. Long-range transport adds a significant degree of difficulty to all of the risks from in-hospital transport. The potential complications of transport include accidentally dislodging life-sustaining devices, diverting attention from physiologic trends to attend to the transport, temporarily suspending access to needed capability, and the chance of a mishap directly related to the transport [ 16 ].
Guidelines for the transport of critically ill adults have been published [ 17 ]. General principles of critical care transport include ensuring that the move is in the patient's best interest, development of a pre-transport plan that meets the patient's ongoing and anticipated needs with no decrease in level of care, and execution of the plan by a well-trained, well-equipped team.
The post-Cold War increase in scope and complexity of military operations drove the need for an agile medical system that could deploy and redeploy rapidly and scale to fit the requirements. At the same time, concepts of damage control surgery for trauma patients were developed, offering a strategy for enhanced survival of combat casualties.
The military required teams that could deploy close to combat units to provide lifesaving surgical resuscitation, but teams capable of providing post-resuscitation care were too large and complex to keep pace with the movements of the forces they supported [ 18 , 19 ].
In response to this situation, the USAF developed Critical Care Aeromedical Transport Teams CCATTs to provide the existing aeromedical evacuation system with an intrinsic capability to rapidly evacuate critical casualties with no decrease in the level of care, allowing the forward surgical units to prepare for the next round of casualties [ 20 ].
This paradigm shift has been employed in the wars in Iraq and Afghanistan. Comparison of mortality data between military conflicts is difficult due to changes in weapons, tactics, and personal protection; nevertheless, survival of combat casualties has been strikingly improved over prior wars and this improvement may be due in part to this system for delivering advanced care [ 19 ]. A CCATT is composed of a physician trained in a critical care-related field, a critical care nurse, and a respiratory therapist.