Immediate Care of the Wounded Introductory ThoughtsClifford C. Cloonan, MD
This text represents a thirty year culmi-nation of my thoughts about pre-hospitalcombat casualty care.My earliest introduction to this topiccame in 1973 when I attended the 91ACombat Medic course in San Antonio Texas, a necessary pre-requisite before Icould attend the 300 F-1 Special ForcesMedic course. It was mostly poorlytaught and improperly focused and for-tunately I never had to take care of any-one in, or out of, a combat situation us-ing only the knowledge gained in thatcourse. It was run by nurses and theacademic focus of the course was onnursing care skills that were mostly ir-relevant to pre-hospital combat casualtycare, presumably the realm of the com-bat medic. Some of the combat skillsinstruction provided by veteran combatmedics with experience in the VietnamWar was a notable exception. The 300 F-1 Special Forces MedicCourse that followed was exactly theopposite; it remains to this date the bestand most intense medical instruction Ihave ever received. I learned more rele-vant medical information in the shortspan of that course than I would everagain learn in a similar time span. Uponcompletion of that course I was leftwondering why it took physicians fouryears of college, four years of medicalschool and several more years of intern-ship and residency training to learn whatI had learned in less than a year; I wasblessedly unencumbered with theknowledge of what I didn’t know andyouthfully confident in my skills andknowledge of combat casualty care. Iwas to never have the opportunity tolearn my shortcomings as a combatmedic since the Vietnam War wounddown faster than I completed my train-ing. It was this training and experienceas a Special Forces medic that sent meon the path to become a military physi-cian.What I learned in the ensuing years isthat most often:
The simple answer is the right an-swer,
Well-performed basic techniquesare usually better for the patientthan more complicated and “so-phisticated” techniques,
Conscious inaction is better thanmindless action,
Training is more important thanequipment, and
The day I graduated from the Spe-cial Forces Medic Course I was“smarter” than I would ever beagain because mostly what Ilearned later was all the thingsthat I didn’t, and would never,know.What I also learned in my nearly thirtyyears in military medicine is that mostpeople believe that all relevant historybegan the day they were born and there-fore nothing much of use for the presentor the future can be learned from thepast.
Nothing could be further from