Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXIX: Wounds of the Abdomen

Consideration of Extenuating Circumstances

United States Department of Defense
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The third action represents the greatest departure from civilian practice because the unique features of combat surgery are considered. The surgeon must maintain concentration and attention to detail in the care of the individual patient at the same time that these conditions are considered. Consideration of these rules often allows the surgeon to make a decision concerning the care of patients in the Priority II classification. The surgeon must keep several factors in mind:

1. There are no inviolable rules.
2. Any change in the patient's condition cancels all previous decisions.
3. The surgeon must know of the availability of blood or blood products. If they are not available or are available in limited supply, the surgeon should tend to classify the patients in a more urgent category. In other words, the surgeon should tend to operate earlier.
4. The surgeon must know the number of beds available for holding (re-evaluation) and postoperative care.
5. The surgeon must consider the available methods of evacuation. This may be prolonged surface evacuation or rapid movement by air.
6. The surgeon should be aware of the likelihood of movement of the hospital or the likelihood of the hospital coming under fire.
7. The surgeon must appreciate both the quality and quantity of anesthesia support.
8. Knowledge of the availability and sophistication of operative nursing support is critical.
9. The surgeon should know of the availability and sophistication of surgical assistance.
10. Knowledge of the availability of respiratory therapy support for the postoperative patient is essential.
11. Decrements in overall unit efficiency secondary to fatigue must be considered.

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