Should We Teach Every Soldier How to Start Intravenous Fluids

摘要

The recent mandate by the U.S. Army Training and Doctrine Command requiring all Soldiers entering Basic Combat Training after October 1, 2007, to be combat lifesaver (CLS) certified is an outstanding step to improve training across the Army in lifesaving first-aid skills. However, the requirement for all Soldiers to be competent in placing an intravenous (IV) line and initiating treatment with IV fluids, per the current CLS standards, may not be the best use of precious training resources in light of the most recent medical research and battlefield experience. The most important battlefield first-aid skill is controlling hemorrhage, by far the leading and most preventable cause of battlefield death in modern warfare. The main purpose of performing IV catheterization in the setting of trauma is to administer fluids or blood products to treat hemorrhagic shock. For patients in significant hemorrhagic shock, aggressive hemorrhage control at the point of wounding, followed by expeditious transport to surgical care, is most important. Evacuation and subsequent surgical management of noncompressible truncal hemorrhage should not be delayed by attempts to place an IV. Based on the available literature and lessons learned in Iraq and Afghanistan, it is clear that IV placement is not a critical life-saving skill, while hemorrhage control is. Training all Soldiers to start IVs without the requisite understanding of the risks and benefits of who would benefit from IV fluids and who could be harmed could result in many receiving unneeded or detrimental care on the battlefield. Soldiers spend the vast majority of their first-aid training time learning IV placement, the most time-consuming skill in the CLS course, yet one that does not save lives. The only units that may benefit from IV training are units operating far forward with little or no organic medical support, such as Special Operations Forces.