Should we teach every soldier how to start intravenous fluids?

The recent mandate by the US 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. 1 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 the light of the most recent medical research and battlefield experience. The outcome of a battle casualty will often be determined by whoever provides initial care. In most cases this will be a fellow Soldier, not a medic. The CLS course was developed to bridge the gap between self-aid or buddy-aid until care could provided by the platoon combat medic (military occupational specialty 68W). 2 The CLS concept has been further refined over the last decade to reflect the concepts of Tactical Combat Casualty Care (TC3), which focuses on treating the leading causes of preventable battlefield death while minimizing the risk to first-aid providers and the tactical mission. 3 The TC3 concept is possibly the most significant advance in point of injury care since the distribution of the individual field dressing in the late 1800s. 4 The most important battlefield first-aid skill is controlling hemorrhage, by far the leading and most preventable cause of battlefield death in modern warfare. Bellamy showed 9% of those killed in action during the Vietnam conflict died of potentially preventable extremity hemorrhage. 5 A similar fatality rate from compressible extremity hemorrhage in Iraq was demonstrated by Cuadrado et al. 6 Proper tourniquet application is the most important method in the control of severe hemorrhage in the tactical setting. Other lifesaving skills emphasized in the TC3 include needle decompression of a tension pneumothorax and airway management, the second and third leading causes of preventable battle field deaths, causing 4% and 1% of all fatal injuries respectively. The main purpose of performing IV catheterization in the setting of trauma is to administer fluids or blood products to treat hemorrhagic shock. Seven percent of patients on the battlefield require aggressive resuscitation. 11 Current transfusion protocols emphasize fresh whole blood and procoagulants rather than crystalloids to restore organ perfusion, prevent the dilution of clotting factors, and avoid hypothermia. 11 For patients in significant hemorrhagic shock, aggressive hemorrhage control at …