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https://www.readbyqxmd.com/read/28411934/tactical-combat-casualty-care-and-wilderness-medicine-advancing-trauma-care-in-austere-environments
#1
REVIEW
Frank K Butler, Brad Bennett, Colonel Ian Wedmore
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. Military units that have trained all of their unit members in TCCC have now documented the lowest incidence of preventable deaths in the history of modern warfare and TCCC is now the standard for battlefield trauma care in the US Military. TCCC and wilderness medicine share the goal of optimizing care for patients with trauma in austere environments that impose significant challenges in both equipment and evacuation capability...
May 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/28383472/battlefield-pain-management-a-view-of-17-years-in-israel-defense-forces
#2
Avi Benov, Margaux M Salas, Helit Nakar, Ben Antebi, Bader Tarif, Avraham Yitzhak, Elon Glassberg
INTRODUCTION: Pain control in trauma is an integral part of treatment in combat casualty care (CCC). More soldiers injured on the battlefield will need analgesics for pain than those who will need life-saving interventions (LSI). It has been shown that early treatment of pain improves outcomes after traumatic injury, while inadequate treatment leads to higher rates of PTSD. The purpose of this article is to report the Israel Defense Forces Medical Corps (IDF-MC) experience with point of injury (POI) use of analgesia...
April 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28383471/clinical-practice-guideline-adherence-during-operation-inherent-resolve
#3
Timothy P Plackett, Darren C Cherry, Gerald Delk, Steven Satterly, Jared Theler, Derek McVay, Jacqueline Moore, Stacy A Shackelford
BACKGROUND: The Joint Trauma System (JTS) Clinical Practice Guidelines (CPGs) contributed to the decrease in battlefield morality over the past 15 years. However, it is unknown to what degree the guidelines are being followed in current military operations. METHODS: A retrospective review was performed of all patients treated at three separate US Army Role II facilities during the first ten months of Operation Inherent Resolve in Iraq. Charts were reviewed for patient demographics, clinical care, and outcomes...
April 5, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333837/leadership-lessons-learned-in-tactical-combat-casualty-care
#4
Frank K Butler
The US Military has achieved remarkable success in improving survival for our nation's combat wounded throughout the 14 years of conflict in Iraq and Afghanistan. For the prehospital phase of care, where most combat fatalities occur, these advances have been embodied in Tactical Combat Casualty Care (TCCC.) TCCC is a set of evidence-based, best-practice, prehospital trauma care guidelines that are customized for use on the battlefield. The TCCC Guidelines have been updated on an ongoing basis over the last 15 years through the work of the Committee on TCCC and the TCCC Working Group...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28333833/leadership-and-a-casualty-response-system-for-eliminating-preventable-death
#5
Russ S Kotwal, Harold R Montgomery, Ethan A Miles, Curtis C Conklin, Michael T Hall, Stanley A McChrystal
Combat casualties who die from their injuries do so primarily in the prehospital setting. Although most of these deaths result from injuries that are non-survivable, some are potentially survivable. Of injuries that are potentially survivable, most are from hemorrhage. Thus, military organizations should direct efforts toward prehospital care, particularly through early hemorrhage control and remote damage control resuscitation, in order to eliminate preventable death on the battlefield. A systems-based approach and priority of effort for institutionalizing such care was developed and maintained by medical personnel and command-directed by non-medical combatant leaders within the 75th Ranger Regiment, U...
March 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28328685/whole-blood-transfusion-closest-to-the-point-of-injury-during-french-remote-military-operations
#6
Yann Daniel, Anne Sailliol, Thomas Pouget, S├ębastien Peyrefitte, Sylvain Ausset, Christophe Martinaud
To improve the survival of combat casualties, interest in the earliest resort to whole blood (WB) transfusion on the battlefield has been emphasized. Providing volume, coagulation factors, plasma and oxygenation capacity, WB appears actually as an ideal product severe trauma management. WB can be collected in advance, and stored for subsequent utilization, or can be drawn, directly on the battlefield, once a soldier is wounded, from an uninjured companion and immediately transfused.Such concepts require a great control of risks at each step, especially regarding ABO mismatches, and transfusion transmitted diseases...
March 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28318991/bleeding-control-using-hemostatic-dressings-lessons-learned
#7
REVIEW
Brad L Bennett
Based on lessons learned, many military battlefield trauma advances ultimately transition to enhance civilian trauma care. However, even with major strides to enhance battlefield hemorrhage control, it is unclear how effectively these techniques and products are being translated to civilian trauma. The purpose of this brief review is to present the evidence of current hemostatic product effectiveness, determine the evidence for transitioning of this technology to prehospital civilian application, and provide recommendations about potential use in the wilderness/austere setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28291503/regenerative-and-antibacterial-properties-of-acellular-fish-skin-grafts-and-human-amnion-chorion-membrane-implications-for-tissue-preservation-in-combat-casualty-care
#8
Skuli Magnusson, Baldur Tumi Baldursson, Hilmar Kjartansson, Ottar Rolfsson, Gudmundur Fertram Sigurjonsson
BACKGROUND: Improvised explosive devices and new directed energy weapons are changing warfare injuries from penetrating wounds to large surface area thermal and blast injuries. Acellular fish skin is used for tissue repair and during manufacturing subjected to gentle processing compared to biologic materials derived from mammals. This is due to the absence of viral and prion disease transmission risk, preserving natural structure and composition of the fish skin graft. OBJECTIVES: The aim of this study was to assess properties of acellular fish skin relevant for severe battlefield injuries and to compare those properties with those of dehydrated human amnion/chorion membrane...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28291449/the-afghan-theater-a-review-of-military-medical-doctrine-from-2008-to-2014
#9
Ian Lane, Zsolt Stockinger, Samual Sauer, Mark Ervin, Michael Wirt, Stephen Bree, Kirby Gross, Jeffrey Bailey, Brig Timothy Hodgetts, Elizabeth Mann-Salinas
This article forms part of a series that will explore the effect that Role 2 (R2) medical treatment facilities (MTFs) had on casualty care during the military campaign in Afghanistan and how we should interpret this to inform the capabilities in, and training for future R2 MTFs. Key aspects of doctrine which influence the effectiveness of R2 MTFs include timelines to care, patient movement capabilities, and MTF capabilities. The focus of this analysis was to review allied doctrine from the United States, United Kingdom, and the North Atlantic Treaty Organization to identify similarities and differences regarding employment of R2 related medical assets in the Afghan Theater, specifically for trauma care...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290958/comparative-assessment-of-three-approaches-of-teaching-nonmedically-trained-persons-in-the-handling-of-supraglottic-airways-a-randomized-controlled-trial
#10
Mario Hensel, Willi Schmidbauer, Michael Benker, Paula Schmieder, Thoralf Kerner
BACKGROUND: The use of supraglottic airways has been recommended in combat trauma airway management. To ensure an adequate airway management on the battlefield, suitable training concepts are sought to efficiently teach as many soldiers as possible. Our aim was to compare three approaches of teaching laypersons in the handling of supraglottic airways in a mannequin model. METHODS: In this prospective randomized blinded study, 285 military service men without any medical background were divided into three groups and trained in the use of the Laryngeal Mask Airway Supreme (LMA) and the Laryngeal Tube Disposable (LT-D)...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290957/oral-maxillofacial-injury-surveillance-of-u-s-military-personnel-in-iraq-and-afghanistan-2001-to-2014
#11
Timothy A Mitchener, Rodney Chan, John W Simecek
BACKGROUND: Cranial and oral-maxillofacial injuries accounted for 33% of military visits to in-theater (Level III) military treatment facilities for battle injuries during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Even after years of conflict, the size and scope of oral-maxillofacial injuries in military armed conflict is still not fully understood. This study reports U.S. Department of Defense (DoD) rates of oral-maxillofacial injuries that can be used for further surveillance and research...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28290925/two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#12
Frank K Butler
BACKGROUND: Twenty years ago, the original Tactical Combat Casualty Care (TCCC) article was published in this journal. Since TCCC is essentially a set of best-practice prehospital trauma care guidelines customized for use on the battlefield, the presence of a journal with a specific focus on military medicine was a profound benefit to the initial presentation of TCCC to the U.S. Military. METHODS: In the two ensuing decades, which included the longest continuous period of armed conflict in our nation's history, TCCC steadily evolved as the prehospital trauma care evidence base was augmented and as feedback from user medics, corpsmen, and pararescuemen was obtained...
March 2017: Military Medicine
https://www.readbyqxmd.com/read/28285483/a-perspective-on-the-potential-for-battlefield-resuscitative-endovascular-balloon-occlusion-of-the-aorta
#13
Ryan M Knight
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has a place in civilian trauma centers in the United States, and British physicians performed the first prehospital REBOA, proving the concept viable for civilian emergency medical service. Can this translate into battlefield REBOA to stop junctional hemorrhage and extend "golden hour" rings in combat? If yes, at what level is this procedure best suited and what does it entail? This author's perspective, after treating patients on the battlefield and during rotary wing evacuation, is that REBOA may have a place in prehospital resuscitation but patient and provider selection are paramount...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28285480/pediatric-trauma-management-from-an-austere-prospective
#14
Joycelynn Gray, Derek R Linklater, James Johnston, Benjamin Donham
Pediatric trauma represents a notable proportion of casualties encountered by Combat medics, physician assistants, and physicians while in the deployed setting. Most of these resuscitation teams receive limited pediatric- specific training and suffer subsequent emotional stress due the perceived high-stakes nature of caring for gravely wounded children. Even when children survive long enough to arrive at combat support hospitals, there remain high risks for morbidity and mortality for many of them. There are numerous reports of the epidemiological characteristics of these pediatric patients, the common mechanisms of injury, the hospital lengths of stay, and calls for pediatric-specific equipment and specialist presence in-theatre...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28284483/tactical-combat-casualty-care-beginnings
#15
REVIEW
Frank K Butler
Tactical Combat Casualty Care (TCCC) is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield. The origins of TCCC were nontraditional. The TCCC program began as a Naval Special Warfare biomedical research effort launched after the realization that extremity hemorrhage, a leading cause of preventable death on the battlefield, was not being treated with a readily available and highly effective intervention: the tourniquet. This insight prompted a systematic reevaluation of all aspects of battlefield trauma care that was conducted from 1993 to 1996 as a joint effort by special operations medical personnel and the Uniformed Services University of the Health Sciences...
March 8, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28230629/point-of-injury-tourniquet-application-during-operation-protective-edge-what-de-we-learn
#16
Amir Shlaifer, Avraham Yitzhak, Erez N Baruch, Avi Shina, Alexandra Satanovsky, Amiram Shovali, Ofer Almog, Elon Glassberg
BACKGROUND: Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate and short term outcomes of point of injury (POI) tourniquet applications during 'Operation Protective Edge' (OPE). METHODS: A case series study regarding tourniquet application at the POI during OPE was collected...
February 23, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28225742/review-of-military-and-civilian-trauma-registries-does-consensus-matter
#17
Thijs T C F van Dongen, Johan de Graaf, Eelco P Huizinga, Howard R Champion, Rigo Hoencamp, Luke P H Leenen
BACKGROUND: Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use different methods of data management, compromising international comparison of trauma systems. The aim of this review is to aid in reaching international (coalition-wide) consensus for compatible data collection methods with uniform definitions, which is needed for transnational research and subsequent improvement of medical support organizations...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28195889/a-biodegradable-hemostatic-gelatin-polycaprolactone-composite-for-surgical-hemostasis
#18
Niann-Tzyy Dai, Keng-Yen Fu, Pai-Shan Hsieh, Yu-Min Hung, Yun-Lung Fang, Nien-Chi Huang, Tzu-Wei Lu, Lien-Guo Dai, Shyi-Gen Chen, Tim-Mo Chen
Massive bleeding is the leading cause of battlefield-related deaths and the second leading cause of deaths in civilian trauma centers. One of the challenges of managing severe wounds is the need to promote hemostasis as quickly as possible, which can be achieved by using hemostatic dressings. In this study, we fabricated 2 kinds of gelatin/polycaprolactone composites with 2 ratios of gelatin/polycaprolactone, 1:1 and 2:1 (GP11 and GP21, respectively). Scanning electron microscopy revealed that the GP11 composite exhibited rougher and more porous structure than the GP21 composite did...
March 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28179044/translating-battlefield-practices-to-disaster-health
#19
Kandra Strauss-Riggs, Kevin Yeskey, Aubrey Miller, Stacey Arnesen, Craig Goolsby
We review aspects of the recently released National Academies of Sciences, Engineering, and Medicine report A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury most relevant to disaster health, particularly the concepts of focused empiricism and building a learning health system. The article references battlefield success utilizing these concepts and the emerging Disaster Research Response Program. We call upon disaster health researchers to apply the report's recommendations to their work...
February 9, 2017: Disaster Medicine and Public Health Preparedness
https://www.readbyqxmd.com/read/28102530/surgeon-preparedness-for-mass-casualty-events-adapting-essential-military-surgical-lessons-for-the-home-front
#20
Kyle N Remick, Stacy Shackelford, John S Oh, Jason M Seery, Daniel Grabo, John Chovanes, Kirby R Gross, Shawn C Nessen, Nigel Rm Tai, Rory F Rickard, Eric Elster, C W Schwab
Military surgeons have gained familiarity and experience with mass casualty events (MCEs) as a matter of routine over the course of the last two conflicts in Afghanistan and Iraq. Over the same period of time, civilian surgeons have increasingly faced complex MCEs on the home front. Our objective is to summarize and adapt these combat surgery lessons to enhance civilian surgeon preparedness for complex MCEs on the home front. The authors describe the unique lessons learned from combat surgery over the course of the wars in Afghanistan and Iraq and adapt these lessons to enhance civilian surgical readiness for a MCE on the home front...
April 2016: American Journal of Disaster Medicine
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