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Tactical Combat Casualty Care

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https://www.readbyqxmd.com/read/27753568/compatibility-of-hydroxyethyl-starch-and-tranexamic-acid-for-battlefield-co-administration
#1
Nicholas M Studer, Ahmad H Yassin, Donald E Keen
INTRODUCTION: The current Tactical Combat Casualty Care Guidelines recommend tranexamic acid (TXA) administration for casualties in whom massive blood transfusion is anticipated. However, despite Hextend being the recommended resuscitation fluid, the guidelines recommend against using TXA with Hextend. This appears to be due to a concern about pharmaceutical compatibility, despite the absence of a direct study of compatibility in the literature. METHODS: Two solutions of Hextend and TXA were examined for compatibility...
October 2016: Military Medicine
https://www.readbyqxmd.com/read/27734441/evaluation-of-two-junctional-tourniquets-used-on-the-battlefield-combat-ready-clamp%C3%A2-versus-sam%C3%A2-junctional-tourniquet
#2
Jean-Guillaume Meusnier, Charles Dewar, Erti Mavrovi, Frederic Caremil, Pierre-Francois Wey, Jean-Yves Martinez
BACKGROUND: Junctional hemorrhage (i.e., between the trunk and limbs) are too proximal for a tourniquet and difficult to compress. These hemorrhages are responsible for 20% of preventable deaths by bleeding on the battlefield. The majority of these involve the groin area. Devices allowing a proximal compression for arterial axes have been recently developed. OBJECTIVE: The purpose of this study was to compare the use of two junctional- tourniquet models, the Combat Ready Clamp (CRoC®) and the SAM® Junctional Tourniquet (SJT), in simulated out-of-hospital trauma care when tourniquets were ineffective to stop the arterial flow...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27689383/committee-on-tactical-combat-casualty-care-meeting-2-3-february-2016-atlanta-georgia-meeting-minutes
#3
Anonymous Anonymous
No abstract text is available yet for this article.
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27689382/tactical-combat-casualty-care-top-lessons-for-civilian-ems-systems-from-14-years-of-war
#4
Frank K Butler
No abstract text is available yet for this article.
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27405067/tactical-study-of-care-originating-in-the-prehospital-environment-tacscope-acute-traumatic-coagulopathy-on-the-contemporary-battlefield
#5
Robert T Gerhardt, Elon Glassberg, John B Holcomb, Robert L Mabry, Martin B Schreiber, Philip C Spinella
BACKGROUND: Uncontrolled major hemorrhage and delayed evacuation remain substantial contributors to potentially survivable combat death, along with mission, environment, terrain, logistics, and hostile action. Life-saving interventions and the onset of acute traumatic coagulopathy (ATC) may also contribute. OBJECTIVE: Analyze US casualty records from the DoD Trauma Registry, using International Normalized Ratio (INR) of 1.5 for onset of ATC. METHODS: Retrospective cohort study from September 2007 to June 2011, inclusive...
September 2016: Shock
https://www.readbyqxmd.com/read/27215893/lessons-learned-employment-and-tactical-use-of-the-combat-medic-during-stability-support-operations
#6
Michael S Eldred
It is the intent of this article to define the strategy by which Combat Medics have been employed in contemporary stability operations and counterinsurgency conflicts. This article describes the advances in training based on Tactical Combat Casualty Care and how training evolved into an evidence-based model. Training platforms evolved with shifts in mission requirements, new technology, improved medical techniques, and changing protocols. The last portion of this article details recommendations in doctrine, materiel, and training that could enable optimal sustainment standards while retaining operational capability across a wide variety of combat and peace operations...
April 2016: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/27215877/infection-prevention-in-the-deployed-environment
#7
Heather C Yun, Clinton K Murray
Up to 50% of combat injured patients from recent conflicts have suffered infectious complications, predominantly with multidrug-resistant (MDR) bacteria acquired nosocomially in the chain of tactical combat casualty care. These bacteria have ranged from MDR Acinetobacter baumannii-calcoaceticus associated with Operation Iraqi Freedom (OIF), to extended spectrum beta-lactamase producing Enterobacteriaceae from operations in Afghanistan. Experience from interventions at Level III facilities demonstrate that basic infection control (IC) procedures, such as improvements in hand hygiene, use of ventilator associated pneumonia bundles, and antimicrobial stewardship, can improve outcomes even in austere environments...
April 2016: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/27215873/battlefield-documentation-of-tactical-combat-casualty-care-in-afghanistan
#8
John B Robinson, Michael P Smith, Kirby R Gross, Samual W Sauer, James J Geracci, Charlie D Day, Russ S Kotwal
Performance improvement is reliant on information and data, as you cannot improve what you do not measure. The US military went to war in 2001 without an integrated trauma care system to collect and analyze combat casualty care data. By 2006, the conflict in Afghanistan began appreciating the capture and consolidation of hospital care documentation into the Department of Defense Trauma Registry. In contrast, a paucity of documentation has existed for prehospital or tactical combat casualty care (TCCC). Using the 75th Ranger casualty documentation model established in 2005, the Joint Trauma System developed a casualty data collection system for prehospital care using the TCCC Card, the TCCC After Action Report (AAR), and the Prehospital Trauma Registry...
April 2016: U.S. Army Medical Department Journal
https://www.readbyqxmd.com/read/27045493/evaluation-and-testing-of-junctional-tourniquets-by-special-operation-forces-personnel-a-comparison-of-the-combat-ready-clamp-and-the-junctional-emergency-treatment-tool
#9
COMPARATIVE STUDY
Charalampos A Theodoridis, Kelly E Kafka, Alejandro M Perez, Jeremy B Curlee, Paul C J Yperman, Nico Oppermann, Eirik Holmstroem, Derek D Niegsch, Antonio Mannino, Nicola Ramundo
BACKGROUND: Previous research has shown that external hemorrhage from proximal leg amputations and junctional sites represents 19.2% of potentially survivable lethal hemorrhage. A recent effort to address this problem has resulted in the development of various junctional tourniquets. This study assessed and compared two Tactical Combat Casualty Care Committee-approved junctional tourniquets, the Combat Ready Clamp (CRoC) and the Junctional Emergency Treatment Tool (JETT), to contribute to their future development and to better inform on the decisions for device selection by military units...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/27045490/management-of-external-hemorrhage-in-tactical-combat-casualty-care-the-adjunctive-use-of-xstat%C3%A2-compressed-hemostatic-sponges-tccc-guidelines-change-15-03
#10
Kyle Sims, Harold R Montgomery, Paul Dituro, Bijan S Kheirabadi, Frank K Butler
Exsanguination from wounds in the so-called junctional regions of the body (i.e., the neck, the axilla, and the groin) was responsible for 19% of the combat fatalities who died from potentially survivable wounds sustained in Afghanistan or Iraq during 2001 to 2011. The development of improved techniques and technology to manage junctional hemorrhage has been identified in the past as a high-priority item by the Committee on Tactical Combat Casualty Care (CoTCCC) and the Army Surgeon General's Dismounted Complex Blast Injury (DCBI) Task Force...
2016: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26540712/control-of-junctional-hemorrhage-in-a-consensus-swine-model-with-hemostatic-gauze-products-following-minimal-training
#11
Sean P Conley, Lanny F Littlejohn, Jose Henao, Sara S DeVito, Gregory J Zarow
OBJECTIVE: Uncontrolled hemorrhage from junctional wounds that cannot be controlled by traditional tourniquets accounts for one in five preventable battlefield exsanguination deaths. Products for treating these wounds are costly and require special training. However, chemically treated gauze products are inexpensive, potentially effective, and require only minimal training. This study was designed to assess the efficacy of three hemostatic gauze products following brief training, using a consensus swine groin injury model...
November 2015: Military Medicine
https://www.readbyqxmd.com/read/26406428/early-in-theater-management-of-combat-related-traumatic-brain-injury-a-prospective-observational-study-to-identify-opportunities-for-performance-improvement
#12
Raymond Fang, Manjunath Markandaya, Joseph J DuBose, Leopoldo C Cancio, Stacy Shackelford, Lorne H Blackbourne
BACKGROUND: Combat-related moderate-to-severe traumatic brain injury (CRTBI) is a significant cause of wartime morbidity and mortality. As of August 2014, moderate-to-severe traumatic brain injuries sustained by members of the Department of Defense worldwide since 2000 totaled 32,996 cases. Previously published epidemiologic reviews describe CRTBI management at a "strategic" level, but they lack "tactical" patient-specific data required for performance improvement. In addition, scarce data exist regarding prehospital CRTBI care...
October 2015: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/26360360/tourniquet-conversion-a-recommended-approach-in-the-prolonged-field-care-setting
#13
Brendon Drew, David Bird, Michael Matteucci, Sean Keenan
Life-saving interventions take precedence over diagnostic maneuvers in the Care Under Fire stage of Tactical Combat Casualty Care. The immediate threat to life with an actively hemorrhaging extremity injury is addressed with the liberal and proper use of tourniquets. The emphasis on hemorrhage control has and will continue to result in the application of tourniquets that may not be needed past the Care Under Fire stage. As soon as tactically allowable, all tourniquets must be reassessed for conversion. Reassessment of all tourniquets should occur as soon as the tactical situation permits, but no more than 2 hours after initial placement...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26360353/the-ranger-first-responder-program-and-tactical-emergency-casualty-care-implementation-a-whole-community-approach-to-reducing-mortality-from-active-violent-incidents
#14
Andrew D Fisher, David W Callaway, Josh N Robertson, Shane A Hardwick, Joshua P Bobko, Russ S Kotwal
Active violent incidents are dynamic and challenging situations that can produce a significant amount of preventable deaths. Lessons learned from the military?s experience in Afghanistan and Iraq through the Committee on Tactical Combat Casualty Care and the 75th Ranger Regiment?s Ranger First Responder Program have helped create the Committee for Tactical Emergency Casualty Care (C-TECC) to address the uniqueness of similar wounding patterns and to end preventable deaths. We propose a whole-community approach to active violent incidents, using the C-TECC Trauma Chain of Survival and a tiered approach for training and responsibilities: the first care provider, nonmedical professional first responders, medical first responders, and physicians and trauma surgeons...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26360351/the-operational-canine-and-k9-tactical-emergency-casualty-care-initiative
#15
Lee E Palmer, Richard Maricle, Jo-Anne Brenner
BACKGROUND: Approximately 20% to 25% of trauma-related, prehospital fatalities in humans are due to preventable deaths. Data are lacking, however, on the nature and the prevalence of operational canine (OC) prehospital deaths. It is plausible that OCs engaged in high-threat operations are also at risk for suffering some type of preventable death. Tactical Combat Casualty Care has significantly reduced human fatality rates on the battlefield. Standardized guidelines specifically for prehospital trauma care have not been developed for the OC caregiver...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26360349/emergency-cricothyroidotomy-in-tactical-combat-casualty-care
#16
Robert Mabry, Alan Frankfurt, Chetan Kharod, Frank Butler
No abstract text is available yet for this article.
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26226529/tactical-damage-control-resuscitation
#17
Andrew D Fisher, Ethan A Miles, Andrew P Cap, Geir Strandenes, Shawn F Kane
Recently the Committee on Tactical Combat Casualty Care changed the guidelines on fluid use in hemorrhagic shock. The current strategy for treating hemorrhagic shock is based on early use of components: Packed Red Blood Cells (PRBCs), Fresh Frozen Plasma (FFP) and platelets in a 1:1:1 ratio. We suggest that lack of components to mimic whole blood functionality favors the use of Fresh Whole Blood in managing hemorrhagic shock on the battlefield. We present a safe and practical approach for its use at the point of injury in the combat environment called Tactical Damage Control Resuscitation...
August 2015: Military Medicine
https://www.readbyqxmd.com/read/26125162/saving-lives-on-the-battlefield-part-ii-one-year-later-a-joint-theater-trauma-system-and-joint-trauma-system-review-of-prehospital-trauma-care-in-combined-joint-operations-area-afghanistan-cjoa-a-final-report-30-may-2014
#18
Samual W Sauer, John B Robinson, Michael P Smith, Kirby R Gross, Russ S Kotwal, Robert L Mabry, Frank K Butler, Zsolt T Stockinger, Jeffrey A Bailey, Mark E Mavity, Duncan A Gillies
The United States has achieved unprecedented survival rates, as high as 98%, for casualties arriving alive at the combat hospital. Our military medical personnel are rightly proud of this achievement. Commanders and Servicemembers are confident that if wounded and moved to a Role II or III medical facility, their care will be the best in the world. Combat casualty care, however, begins at the point of injury and continues through evacuation to those facilities. With up to 25% of deaths on the battlefield being potentially preventable, the prehospital environment is the next frontier for making significant further improvements in battlefield trauma care...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26125161/replacement-of-promethazine-with-ondansetron-for-treatment-of-opioid-and-trauma-related-nausea-and-vomiting-in-tactical-combat-casualty-care
#19
Dana J Onifer, Frank K Butler, Kirby R Gross, Edward J Otten, Robert Patton, Robert J Russell, Zsolt Stockinger, Elizabeth Burrell
The current Tactical Combat Casualty Care (TCCC) Guidelines recommend parenteral promethazine as the single agent for the treatment of opioid-induced nausea and/or vomiting and give a secondary indication of "synergistic analgesic effect." Promethazine, however, has a well-documented history of undesired side effects relating to impairment and dysregulation of the central and autonomic nervous systems, such as sedation, extrapyramidal symptoms, dystonia, impairment of psychomotor function, neuroleptic malignant syndrome, and hypotension...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/26102046/effects-of-sternal-intraosseous-and-intravenous-administration-of-hextend-on-time-of-administration-and-hemodynamics-in-a-swine-model-of-hemorrhagic-shock
#20
Don Johnson, Christian Penaranda, Kent Phillips, Daniel Rice, Lauren Vanderhoek, Brian Gegel, James Burgert, Jose Blanco
OBJECTIVE: Disasters may cause traumatic injuries leading to hemorrhage. Hemorrhage is the leading cause of death for military and civilian trauma casualties. The US Army's Tactical Combat Casualty Care guidelines recommend administering a 500 mL Hextend bolus via the intravenous (IV) or intraosseous (IO) routes for patients in hypovolemic shock. The purposes of this study were to compare administration time of Hextend and the effects on hemodynamics when Hextend is administered by the sternal IO (SIO) and IV routes in a swine model of hemorrhagic shock...
2015: American Journal of Disaster Medicine
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