Military medicine
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Despite improved body armor, hemorrhage remains the leading cause of preventable death on the battlefield. Trauma to the junctional areas such as pelvis, groin, and axilla can be life threatening and difficult to manage. The Abdominal Aortic Tourniquet (AAT) is a prehospital device capable of preventing pelvic and proximal lower limb hemorrhage by means of external aortic compression. ⋯ Blood flow in the CFA was eliminated in 15 out of 16 participants. The one unsuccessful subject was above average height, weight, body mass index, and abdominal girth. This study shows the AAT to be effective in the control of blood flow in the pelvis and proximal lower limb and potentially lifesaving.
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Airway compromise is a contributor to preventable mortality on the battlefield. Supraglottic airway devices are an accepted intervention for these casualties. Combat Medics, civilian prehospital care providers, and lay civilians have demonstrated proficiency with supraglottic airways. However, the Combat Lifesaver (CLS) course includes no instruction on their use. ⋯ CLS students are capable and confident in the use of a supraglottic airway device after only brief instruction.
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The Combat Lifesaver course taught to nonmedical personnel includes instruction on performing needle thoracostomy to decompress tension pneumothorax, the second leading cause of preventable combat death. Although the Tactical Combat Casualty Care curriculum is pushed to the lowest level of battlefield first responders, the instruction of this advanced procedure is routinely limited to a verbal block of instruction with a standardized presentation. ⋯ Cadaver training provided the largest single educational confidence boost for needle decompression skills, and is an effective method of enhancing confidence in needle decompression.
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Randomized Controlled Trial Multicenter Study
Identification of barriers to adaptation of battlefield technologies into civilian trauma in California.
To characterize the adoption of routine battlefield medical techniques (tourniquets, hemostatic agents, and tactical combat casualty care into civilian prehospital trauma care and to identify the barriers to their use in the state of California through anonymous electronic survey of local emergency medical services agency (LEMSA) directors. ⋯ Tourniquets, hemostatic agents, and tactical medical care are the integral components of battlefield medicine and have been lifesaving in these settings. The barriers to this transition are multifactorial. Physicians familiar with these technologies should become advocates for their integration in civilian trauma patient care.
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The study establishes the functional outcomes of service personnel injured in current conflicts by correlating data on initial injury to the findings of medical boards after trauma and reconstructive treatment. Data comprehensively include all casualties of the Royal Navy and Royal Marines and all functional outcomes. ⋯ The Defence Medical Service (DMS) provides excellent trauma and rehabilitative care. The authors contend that this is a valid proxy for other larger coalition formations. Specific injury patterns have higher impact on functional outcomes; future research efforts should focus on these areas.