Expectant and End of Life Care in a Combat Zone

Abstract

A severely wounded soldier arrives by helicopter at your Combat Support Hospital or Forward Surgical Team. Half of his abdominal wall is missing with exposed viscera and active bleeding. He arrests on arrival and you get him back with an emergency department thoracotomy and aortic cross clamp. In the operating room you start on his abdomen while anesthesia continues to resuscitate with blood products. He has so many injuries you don’t know where to begin, but you get to work and are finally gaining ground when the pagers go off again. Seven “urgent surgical” patients are inbound, and your anesthesiologist tells you he just hung the tenth unit of blood, which is half of your total blood supply. All eyes are on you – what are you going to do? Do you continue and exhaust your unit’s blood supply on this patient with a low probability of survival? Do you stop and make this patient “expectant,” allowing him to die so that you can tend to the other injured patients?

Deployment Experience:

Robert M. Rush Jr Chief, General Surgery and Trauma, 10th Combat Support Hospital, Tuzla, Bosnia-Herzegovina, 1999

General Surgeon, 250th Forward Surgical Team, Kandahar Airfield, Kandahar, Afghanistan, 2001–2002

Deputy Commander, 250th Forward Surgical Team, Kirkuk, Iraq, 2003

Deputy Commander Clin Services, Craig Joint Theater Hospital, Bagram Airfield, Afghanistan, 2009

Matthew J. Martin Chief of Surgery, 47th Combat Support Hospital, Tikrit, Iraq, 2005–2006

Chief, General Surgery and Trauma, Theater Consultant-General Surgery, 28th Combat Support Hospital, Baghdad, Iraq, 2007–2008