It may be that due to experience with the degree of insult and intimate knowledge of what they have to work with and what condition is best for the ROLE 2 to receive them, they go to a surgical airway more directly.
I'm interested in the reappearance of "The Golden Hour". My understanding was that the concept sort of took off during the Korean War and was codified/promoted by Dr Cowley. I JUST read his statement; it was that in one hour OR LESS the measures to assure a positive outcoem, even if it was much later, were decided.
http://en.wikipedia.org/wiki/Golden_hour_(medicine)
That may have reflected concurrent concepts of survivability, technic, and care before and during transport different than we use today Stateside.
Personally, I am really not sure how or where that golden hour was decided. I have heard multiple accounts from a bar to the battlefield.
I find the idea of "assuring" a good outcome on trauma during a time when MVA (and therefore largely multisystem blunt and penetrating simultaneously) was the major civilian injury.
Given the facts about blunt trauma resuscitation, I can only conclude that 60 minutes was more of a realistic number than an actual medical truth.
As was accurately stated above, on the battlefield, we are talking about penetrating trauma, on adults selected for their health. The answer to bloodloss is blood replacement, but that is not the end of injury.
Otherwise, we would just sew people up, give them some blood, and they should be ready to return to work.
But something that needs to be understood is that the military trauma system is inherently different from civilian trauma. (Not just because they reverse the number designations on their centers.)
They have a multi-layered approach that is extraordinarily expensive. Likely it will never be replicated in the civilian world becase of this cost. From my study and experience of trauma, for certain it is superior to the civilian side.
But that also means that the factors involved cause completely different outcomes.
For example, a wounded soldier is taken to forward surgery to stop ongoing damage, 10minutes to an hour. Once that ongoing insult is reduced, if not stopped, they are then transfered to a higher level of care.
In the civilian world, ineffective treatment is often initiated that does not stop the insult, because what does is some sort of modern surgical intervention which is not available at the outlying facility.
Instead "resuscitation" is attempted medically, while they wait to transfer. By the time they actually wind up someplace that can help them, they are looking at perhaps an hour or more of ongoing insult, even as they sat in a healthcare center getting "treatment."
When they finally do hit their destination, the idea of and time for rapid surgical stabilization is over. The idea becomes definitive surgical repair and punt to ICU where the goal is discharge ASAP.
This creates a whole different reality in medical therapy. Both for survival and maximizing function after hospitalization.
It is why not everything that works in the military works in the civilian world. Unless you can replicate the entire system, many things are just not going to port over.
Do I wish we could set up a trauma system similar to modern first world militaries?
Hell yes, and twice on Sunday!
But it will require a massive overhaul, from the very way surgeons and critical care experts are trained, to where they are placed, to how they are paid, to purposefully prolonging patient time in the higher levels of the system (Surgery and ICU)
For trauma alone, it will take a massive increase in funding, in a patient population that is basically indigent.
We can marvel at what the military does all day, but we cannot expect the same outcomes trying to implement the "cool looking" parts without the behind the scenes things that really make it work.
