U.S. Army Medical Department journal
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Many combat-related deaths occur in the prehospital environment before the casualty reaches a medical treatment facility. The tenets of Tactical Combat Casualty Care (TCCC) were published in 1996 and integrated throughout the 75th Ranger Regiment in 1999. In order to validate and refine TCCC protocols and procedures, a prehospital trauma registry was developed and maintained. The application of TCCC, in conjunction with validation and refinement of TCCC through feedback from a prehospital trauma registry, has translated to an increase in survivability on the battlefield.
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Uncontrolled hemorrhage remains the leading cause of potentially preventable death in combat casualties. In the current conflict, nearly two-thirds of these deaths occurred as a result of torso injuries with noncompressible hemorrhage and one-third from extremity injuries with compressible bleeding. ⋯ To provide combat medics with the best means of treating hemorrhages, it is essential to understand the mechanism of action, efficacy strength, and possible adverse effects of each available hemostatic agent. In this article, we review the risks and benefits of the agents/dressings that have been used on the battlefield, the process that led to the selection of the new agents, and the present deficiencies that must be addressed in the development of new products.
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Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. ⋯ A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat Medical Voice Documentation System, and establishment of the Remote Trauma Outcomes Research Network.