Practicing Military Medicine in Truly Austere Environments: What to Expect, How to Prepare, When to Improvise.

The majority of the published literature on contemporary military medicine contradicts the concept of austere. Operational medicine is part of every armed conflict around the world, while armed forces of most countries internationally have limited medical resources especially in the front line. The aim of this review is to identify the particularities of a truly austere environment and present a short guide of preparation and action for military medical personnel internationally. An exhaustive search of the existing English literature on operational and military medicine in austere environments was carried out in EMBASE and PubMed databases. This review included seminal and contemporary papers on the subject and synthesized a multiperspective short guide for operational medical personnel. Experience from forward surgical teams of the U.S. Army and humanitarian teams of physicians in war zones who work under precarious and austere circumstances has shown that the management of casualties requires different strategies than in higher levels of combat casualty care and in a civilian setting. A number of factors that must be controlled can be categorized into human, environmental, equipment-related, and socioeconomic. Surgeons and other medical personnel should have knowledge of these aspects beforehand and be adequately trained in peacetime. Physicians must master a number of essential skills and drugs, and be familiar with dosage regimens and side effects. The military surgeon must be specially trained and prepared to use a wide range of skills in truly austere environments in contemporary conflicts.

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