Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
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There are many challenges to treating life-threatening injuries for a healthcare provider deployed to a remote location in a combat setting. Once conventional treatment protocols for exsanguinating hemorrhage have been exhausted and no medical evacuation platform is available, a nonconventional method of treatment to consider is a fresh whole blood (FWB) transfusion. ⋯ While the ultimate outcome was death in this case report, the patient arrived to a surgical team 15 hours after his injury, alert and oriented. In this scenario, FWB transfusion gave this patient the best chance of survival.
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Multicenter Study Observational Study
Prehospital and en route cricothyrotomy performed in the combat setting: a prospective, multicenter, observational study.
Airway compromise is the third most common cause of potentially preventable combat death. Surgical cricothyrotomy is an infrequently performed but lifesaving airway intervention. There are limited published data on prehospital cricothyrotomy in civilian or military settings. Our aim was to prospectively describe the survival rate and complications associated with cricothyrotomy performed in the military prehospital and en route setting. ⋯ In our prospective, multicenter study evaluating cricothyrotomy in combat, procedural success was higher than previously reported. In addition, the majority of cricothyrotomies were performed by the evacuation helicopter medic rather than the prehospital combat medic. Prehospital military medics should receive training in decision making and be provided with adjuncts to facilitate this lifesaving procedure.
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Pressure distribution over tourniquet width is a determinant of pressure needed for arterial occlusion. Different width tensioning systems could result in arterial occlusion pressure differences among nonelastic strap designs of equal width. ⋯ The narrower tensioning system Tactical RMT has better performance characteristics than the Mass Casualty RMT. The 3.8 cm-wide RMTs have some pressure and effectiveness similarities and differences compared with the CAT. Clinically significant pressure changes occur under nonelastic strap tourniquets with muscle tension changes and over time periods as short as 1 minute. An examination of pressure and occlusion changes beyond 1 minute would be of interest.
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Comparative Study
Prehospital emergency care: evaluation of the junctional emergency tourniquet tool with a perfused cadaver model.
Junctional bleeding from the groin is a leading cause of potentially preventable death on the battlefield. To address this problem, a novel device called the Junctional Emergency Treatment Tool (JETT™) was developed. The JETT was designed to stabilize pelvic ring fractures while controlling lower extremity bleeding sustained during high-energy traumatic events on the battlefield and in the civilian environment. Our purpose was to assess the effectiveness of the JETT in the control of simulated life threatening hemorrhage from proximal injuries in the groin of a perfused cadaver. ⋯ The JETT is a single device capable of effectively and quickly controlling bilateral lower extremity junctional hemorrhage at normal physiological blood pressures.
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Comparative Study
Management of open chest wounds in tactical emergency casualty care: application of vented versus nonvented chest seals.
The 2014 midyear, full meeting of the Committee for Tactical Emergency Combat Care (C-TECC) was hosted by the Johns Hopkins University Center for Law Enforcement Medicine on June 9 and 10 in Baltimore, Maryland. As the C-TECC guidelines are increasingly recognized as the best-practice recommendations for civilian, high-threat, prehospital trauma response, a focused guidelines discussion occurred to develop best-practice recommendations for the management of open chest wounds, specifically regarding the application of vented and nonvented chest seals.