Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
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At present, however, there is no systematic, comprehensive quality assurance program for TCCC training throughout the DoD. Individual courses and instructors may or may not use all of the materials in the JTS-approved curriculum; they may or may not add content that is not part of the JTS curriculum; and they may or may not add additional training in the form of advanced simulation, hands-on training with moulaged casualties, graded trauma lanes, or live-tissue training. A recent pilot appraisal of four Tactical Combat Casualty Care for Medical Personnel (TCCC-MP) training courses found that TCCC-MP courses are not presenting all of the course material recommended by the Joint Trauma System (JTS), despite TCCC training having been mandated by the Department of Defense (DoD) for all US military personnel. ⋯ The post-course written testing also needs to use the standardized TCCC fund of knowledge questions and the TCCC Critical Decision Case Study questions developed by the JTS. Finally, there is a need to establish a systematic and standardized quality assurance program to ensure that TCCC training programs are carried out in accordance with the JTS-recommended TCCC curriculum. This program would best be performed as a new function of the CoTCCC with dedicated TCCC course appraisers.
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Airway compromise is the second leading cause of potentially survivable death on the battlefield. Studies show that airway management is a challenge in prehospital combat care with high error and missed opportunity rates. Lacking is user information on the perceived reasons for the challenges. The US military uses several performance improvement and field feedback systems to solicit feedback regarding deployed experiences. We seek to review feedback and after-action reviews (AARs) from end-users with specific regard to airway challenges noted. ⋯ In this review of military lessons learned systems, most of the feedback referenced equipment malfunctions and gaps in initial and maintenance training.This review of AARs provides guidance for targeted research efforts based the needs of the end-users.
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The American College of Surgeons' "Stop the Bleed" (STB) campaign emphasizes how to apply the Combat Application Tourniquet (CAT), a device adopted by the military to control extremity hemorrhage. However, multiple commercially available alternatives to the CAT exist, and it would be helpful for instructors to be knowledgeable about how these other models compare. A PubMed search from January 2012 to January 2020 cross-referenced with a Google search for "tourniquet" was performed for commercially available tourniquets that had been trialed against the CAT. ⋯ Elastic-type tourniquets included were the Stretch, Wrap, And Tuck Tourniquet (SWAT-T), the Israeli Silicone Tourniquet (IST), and the Rapid Activation Tourniquet System (RATS). Ratchet-type tourniquets included were the Ratcheting Medical Tourniquet (RMT) and TX2/TX3 tourniquets, and pneumatic-type tourniquets were the Emergency and Military Tourniquet (EMT) and Tactical Pneumatic Tourniquet (TPT). This review aims to describe the literature surrounding these models so that instructors can help laypeople make more informed purchases, stop the bleed, and save a life.
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Role 1 care represents all aspects of prehospital care on the battlefield. Recent conflicts and military operations conducted on behalf of the Global War on Terrorism have resulted in medical officers (MOs) being used nondoctrinally on combat missions. We are seeking to describe Role 1 trauma care provided by MOs and compare this care to that provided by medics. ⋯ More than half of casualty encounters in this study listed an MO in the chain of care. The difference in proportion of interventions highlights differences in provider skills, training and equipment, or that interventions were dictated by differences in mechanisms of injury.
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The United States (US) military utilizes combat wound medication packs (CWMP) to provide analgesia and wound prophylaxis in casualties who are still able to fight. We compared characteristics of combat casualties receiving CWMP to those not receiving CWMP. We also describe the proportions of casualties with injury patterns consistent with Tactical Combat Casualty Care (TCCC) guideline indications for CWMP use who received this intervention. ⋯ Subjects receiving the CWMP were less severely injured compared to those who did not receive this intervention. The CWMP had very infrequent use among those casualties with injury patterns meeting indications specified in the TCCC Guidelines for use of this intervention.