Battle Casualties in Korea: Studies of the Surgical Research Team, Volume II
Introduction
Lieutenant Colonel William H. Crosby, MC, USA
Volume I of this series has described the response of the body`s several systems to injuries produced by wounds received in combat. Great emphasis was placed upon the nature of this response, that it is not confined to the wounded tissues or systems or organs alone but involves the entire physiologic economy for a prolonged period of time. The damage done by wounding is not confined to the instant of impact but continues so long as bleeding, infection, pain, fear and exposure continue. When the wound is a light one, the response to injury is small and may be self-limited. But unless help is given to those with grave wounds the injury and response proceed crescendo, and some of the reactions may themselves become injurious. "Resuscitation" is the name given to this necessary help, and the means whereby the help is administered are lumped together as the "tools for resuscitation."
Of these tools, surgery is the most important, but the others are essential. They preserve the life of the wounded man, prepare him for the surgical procedure, help him to withstand it and sustain him until he has recovered and convalescence has begun. When the tools for resuscitation are used successfully, they reinforce the body`s response to injury so that the damage is brought quickly under control and healing can occur.
This second volume of the series is concerned with the nature and use of these agents. We know that none of them is perfect. Almost without exception they cause some further injury in addition to their help. Their skillful use takes this into account and seeks to minimize the damage they may do while taking full advantage of the help.
Tools for Resuscitation
Those charged with research of the wounded and their care must recognize the double edge these tools possess and evaluate each one. They must seek to learn how and to what extent these agents help the wounded; they must also gauge the damage that is done in using them, find how the damage may be minimized and how the tools may be improved. Investigation of this sort is difficult. Most of it must confine itself to careful observation of what happens while the wounded
2
The many aspects of resuscitation.
A false appearance of confusion masks a highly efficient resuscitative team.
3
Temporary diversion of the research space and personnel to resuscitation at a time when the clinical facilities were
completely overloaded with casualties.
The breakthrough in the closing months of the conflict filled the entire hospital with casualties. Clinical observations replaced physiologic measurements as the modus operandi of the research unit.
4
man is treated as best we know how. If experiments are devised, they must never compromise the program of resuscitation. Necessity for speed prevents some observations. The welfare of the wounded prevents adequate controls in many phases of research as does the infinite variety of the injuries and the individuals who sustain them. The number of tests that may be done is limited, so that "points of interest" must be subordinated to "points of importance." The limitations of such research are easily recognized. However they may blur the significance of the results, they cannot be avoided. In spite of them, much useful knowledge can be gained and was gained in Korea. It was found, for instance, that the "massive" transfusions given to the most severely wounded were not too large, that the "old" blood used for them had not deteriorated unduly, that plasma substitutes could be used to "stretch" the supply of blood, that the best anesthetic was the least that could do the job. The search to improve the tools of resuscitation was not confined to the bedside. There was a constant effort to provide better agents, fresher blood, even better and safer packaging. The list does not end here, as one may learn from study of the present volume and its companions.
