DOI: 10.1097/TA.0b013e318065b442
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PMID: 17556931
Issn Print: 0022-5282
Publication Date: 2007/06/01
Neuro-Critrical Care in Modern War
Geoffrey Ling; James Ecklund
Excerpt
One historical benefit of war is the introduction of novel approaches to medical care. The current global war on terrorism (GWOT) is no exception. Because of the chronic shortage of deployable military neurosurgeons, in 1999 we introduced the concept of a rapid deployment neurologic team: a neurosurgeon and a neuro-critical care specialist. The latter is a physician, usually a neurologist, who has specialty training in critical care medicine, particularly as it pertains to the nervous system. In 2003, this team was deployed to Afghanistan for Operation Enduring Freedom (OEF) and in 2005 to Baghdad for Operation Iraqi Freedom (OIF). Both deployments affirmed the benefits of this concept. Although the important contributions of the neurosurgeon are well established, the neuro-critical care (NCC) physician’s role is not as widely understood. The NCC specialist is able to bring advanced critical care to neurologically impaired patients. Traditional critical care skills of airway and ventilation management, invasive hemodynamic monitoring, cardiopulmonary resuscitation, infectious disease treatment and others are within the clinical armamentarium of the NCC practitioner. Some additional abilities that have relevance in the deployed environment are use of intracranial pressure and edema monitoring and therapy (including hypertonic saline and pharmacologic coma), transcranial Doppler diagnosis and other neurologic management. Most important, the NCC specialist is able to conduct pre-operative neurologic assessment and post-operative neurologic care. By doing so, it reduces the need to deploy additional neurosurgeons for non-operative tasks. It also ensures that the highest level of neurosurgical and neuro-critical care is rendered to the forward deployed warfighter.
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