Six-Hours-Rule - A Dogma for Military Surgery?
MILITARY HOSPITAL ULM (GERMANY) DEPT OF SURGERY
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Today, the six-hours-rule is a delicate item for military logistics and it is a great challenge for medical services to provide an adequate treatment during the first hours after wounding. DEFINITION Six-hour-rule NATO-ACE-Directive Number 85-8 A principle of support given by the medical service. Surgical treatment should take place as soon as possible, but at last six hours after wounding. This principle directs the location of the first line surgical unit, which can provide life-saving and limb-saving surgical procedures. The unit must be reachable within 4 hours after wounding. HISTORY The rule is the result of traditional surgical experience. Early wound debridement and open wound treatment led to post-primary, secondary healing without infection. Sepsis and death were mostly caused by un-done, late or wrong wound treatment. The rule respects the intolerance of ischemia of traumatised tissue, especially of the skeletal muscle. In addition, the six-hours-rule considers the physiological pathway of contaminated wounds. Germs penetrate healthy tissue with 1mm per hour. Many studies show that the spreading of infection can be reduced by early infusions of potent antibiotics. In this case, the virulence of the most common germs will be three to five times less.
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