Polytrauma

In civilian life, polytraumas often are associated with motor vehicle crashes. This is because car crashes often occur at high velocities, causing multiple injuries. On admission to hospital any trauma patient should immediately undergo x-ray diagnosis of their cervical spine, chest, and pelvis, commonly known as a 'trauma series', to ascertain possible life-threatening injuries. Examples would be a fractured cervical vertebra, a severely fractured pelvis, or a haemothorax. Once this initial survey is complete, x-rays may be taken of the limbs to assess the possibility of other fractures. It also is quite common in severe trauma for patients to be sent directly to CT or a surgery theatre, if they require emergency treatment.

Extracorporeal membrane oxygenation (ECMO) may be effective in treating some polytrauma patients with pulmonary or cardiopulmonary failure.[2]

Polytrauma often results from blast injuries sustained from improvised explosive devices, or by a hit with a rocket-propelled grenade, with "Improvised explosive devices, blasts, landmines, and fragments account[ing] for 65 percent of combat injuries...".[3] The combination of high-pressure waves, explosive fragments, and falling debris may produce multiple injuries including brain injury, loss of limbs, burns, fractures, blindness, and hearing loss,[4] with 60 percent of those injured in this way, having some degree of traumatic brain injury.[3]

In some respects, the high incidence of polytrauma in military medicine is, in fact, a sign of medical advancement, for in previous wars soldiers with such multiple injuries, in most cases, simply did not survive, even if quickly transferred into hospital care. Unfortunately, now many of these victims, although surviving, never will fully regain their previous physical and/or mental form (i.e. they'll be more susceptible to psychological complications, such as PTSD).[3]

U.S. treatment

One of the U.S. clinics specialising in polytrauma, this one in Palo Alto

As of 2013, there were five rehabilitation centers in the U.S. specialising in polytrauma. They are managed by the United States Department of Veterans Affairs and are located in Minneapolis, Minnesota; Palo Alto, California; Richmond, Virginia; San Antonio, Texas, and Tampa, Florida.[4] In addition to the intensive care, insofar as still required, these hospitals mainly specialize in rehabilitative treatment. In addition the Department of Veterans Affairs has 22 polytrauma network sites, located throughout the country.

Veterans Health Administration (VHA) developed a screening and evaluation process to ensure that OEF/OIF/OND Veterans with TBI are identified, and that they receive appropriate treatments and services. This includes mandatory screening for deployment-related TBI of all OEF/OIF/OND Veterans upon their initial entry into VHA for services. Veterans with positive screens are referred for a comprehensive evaluation by TBI specialists for diagnostic and treatment recommendations.

Based on extensive research, the VA-TBI Screening Tool has revealed high sensitivity and moderate specificity allowing VA to identify symptomatic Veterans and develop an appropriate plan of care. From 2007 to 2015, over 900,000 Veterans have been screened for possible OEF/OIF/OND deployment related TBI. Of those, approximately 20 percent had positive screens and were referred for further evaluation. </