Austere military medical care: a graded response.

In war, there has always been a dichotomy between health care needs and resources, and until the mid 18th century, this was an accepted fact of military medicine. However, since then, health care has made remarkable progress based on a belief that a linear periodic deterministic approach will provide solutions to problems. The dichotomy between needs and resources has been recognized or accepted only in disaster or mass casualty medicine, and then only to a limited degree. While degradation to dyssymmetry or chaos and unpredictability is accepted in other scientific disciplines, it has been ignored in medicine. The unpredictability and dissonance inherent in providing military medical care exists, and requires an acceptance of chaos as normal and inevitable. Accordingly, graded responses or austere levels of treatment care plans should be developed that will provide for improved care, particularly in austere military situations.