Head and Face Trauma in Combat Settings

Head and face trauma are among the most complex and life-threatening injuries encountered in combat settings due to their potential to compromise airway, cerebral function, and hemodynamic stability. This chapter explores the combat-centric management of traumatic brain injury (TBI) and maxillofacial trauma, emphasizing rapid recognition, triage, and stabilization in austere environments. Through detailed clinical frameworks and practical guidelines, the text equips frontline medics and emergency responders with essential tools for managing craniofacial injuries under tactical constraints. A structured approach to TBI is presented, including field recognition using AVPU and Glasgow Coma Scale (GCS), neurologic examination, and indications for imaging and neurosurgical referral. Key resuscitative goals—such as prevention of hypoxemia and hypotension, seizure prophylaxis, herniation management, and appropriate use of hypertonic saline and tranexamic acid—are reviewed in detail. The chapter also covers scalp laceration care, employing innovations like Raney clips, hemostatic dressings (e.g., Axiostat®), and hair apposition techniques. In the realm of facial trauma, clinical evaluation strategies address visual disturbances, jaw dysfunction, and signs of skull or orbital fractures. Emergency airway management and bleeding control techniques are highlighted, especially in scenarios with active hemorrhage or avulsed teeth. Special emphasis is placed on pre-hospital care, battlefield adaptability, and damage control principles. A representative combat case scenario contextualizes the challenges and decision-making pathways involved. Together, the content provides an evidence-informed, field-adapted reference for combat medics and clinicians involved in the management of head and face trauma under fire.