Chapter 5
Combat Casualty Care
As the major provider of medical care in Iraq and Afghanistan during the invasion period, Coalition medical personnel faced large numbers of host-nation military and civilian casualties as well as Coalition wounded. With only limited resources to treat local nationals, Coalition facilities in Iraq and Afghanistan established medical rules of eligibility (or medical rules of engagement, MRoE) to regulate the flow of local nationals seeking medical care. Systematic regulations to govern care of other than compatriot wounded are unique to 21st century asymmetric war. Even more astonishing is how emerging practice violated the fundamental ethical norms of medical neutrality during armed conflict by institutionalizing preferential care for multinational forces. The medical rules of eligibility were not exceptions to the principles of medical ethics but very rule.
Another Case
One US soldier and one Iraqi Army [allied] soldier present with a gunshot wound to the chest. Both have low oxygen saturations. There is only enough lidocaine for local anesthesia for one patient, and only one chest tube tray. One will get a chest tube with local anesthesia, and the other will get needle decompression and be monitored by the flight medic.
Who gets the chest tube? Why?
In a workshop, more than 100 American military medical personnel answered this question...
Some Burning Issues
Medical Rules of Eligibility
Ethical Duties of Impartial Care vs. Ethical Duties of Preferential Care
Regulating Triage and Bumping Patients