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https://www.readbyqxmd.com/read/29443864/past-and-present-role-of-ecmo-in-combat-casualty-care-how-far-will-we-go
#1
Jeremy W Cannon, Phillip E Mason, Andriy I Batchinsky
Advanced extracorporeal therapies have been successfully applied in the austere environment of combat casualty care over the previous decade. In this review, we describe the historic underpinnings of extracorporeal membrane oxygenation (ECMO), review the recent experience with both partial and full lung support during combat operations, and critically assess both the current status of the Department of Defense ECMO program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty care...
February 13, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29443862/red-tides-mass-casualty-and-whole-blood-at-sea-red-tides
#2
Benjamin T Miller, Andrew H Lin, Susan C Clark, Andrew P Cap, Joseph J Dubose
BACKGROUND: The U.S. Navy's casualty-receiving ships provide remote damage control resuscitation (RDCR) platforms to treat injured combatants deployed afloat and ashore. We report a significant mass casualty incident aboard the USS Bataan, and the most warm fresh whole blood (WFWB) transfused at sea for traumatic hemorrhagic shock since the Vietnam War. METHODS: Casualty-receiving ships have robust medical capabilities, including a frozen blood bank with packed red blood cells (pRBC) and fresh frozen plasma (FFP)...
February 13, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29437636/outcomes-following-limb-salvage-after-combat-hindfoot-injury-are-inferior-to-delayed-amputation-at-five-years
#3
P M Bennett, T Stevenson, I D Sargeant, A Mountain, J G Penn-Barwell
OBJECTIVES: The surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function. METHODS: Follow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures...
February 2018: Bone & Joint Research
https://www.readbyqxmd.com/read/29432381/systematic-review-of-prehospital-tourniquet-use-in-civilian-limb-trauma
#4
David S Kauvar, Michael A Dubick, Thomas J Walters, John F Kragh
BACKGROUND: Military enthusiasm for limb tourniquet use in combat casualty care has resulted in acceptance by the trauma community for use in the prehospital care of civilian limb injuries. To date there has been no report synthesizing the published data on civilian tourniquet use. The objective of this systematic review was to compile and analyze the content and quality of published data on the civilian use of tourniquets in limb trauma. METHODS: The MEDLINE database was searched for studies on civilian limb tourniquet use in adults published between 2001 and 2017...
February 9, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29432043/prehospital-application-of-hemostatic-agents-in-iraq-and-afghanistan
#5
Steven G Schauer, Michael D April, Jason F Naylor, Joseph K Maddry, Allyson A Arana, Michael A Dubick, Andrew D Fisher, Cord W Cunningham, Anthony E Pusateri
INTRODUCTION: Hemorrhage is the leading cause of death on the battlefield. Development of chitosan- and kaolin-based hemostatic agents has improved hemorrhage control options. Sparse data exists on the use of these agents in the prehospital, combat setting. We describe recent use of these agents and compare patients receiving hemostatic to the baseline population. METHODS: We used a series of emergency department (ED) procedure codes to identify patients within the Department of Defense Trauma Registry (DODTR) from January 2007 to August 2016...
February 12, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29412051/prehospital-analgesia-for-pediatric-trauma-patients-in-iraq-and-afghanistan
#6
Steven G Schauer, Allyson A Arana, Jason F Naylor, Guyon J Hill, Michael D April
BACKGROUND: Previous studies have evaluated prehospital analgesia during combat operations in Iraq and Afghanistan, but were limited to the adult population. However, a significant portion of the casualties of those conflicts were children. We describe the prehospital analgesia administered to wartime pediatric trauma patients. METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients (<18 years of age) admitted to United States and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
February 7, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29401335/influence-of-personality-traits-on-the-effective-performance-of-lifesaving-interventions-example-of-the-tourniquet-application-in-forward-combat-casualty-care
#7
Quentin Vuillemin, Pierre-Eric Schwartzbrod, Pierre Pasquier, Florian Sibille, Marion Trousselard, Marie-Hélène Ferrer
Introduction: Health care delivery in military conflicts implies high-stress environments. Hemorrhage is the first cause of survivable death among combat casualties, and tourniquet application is one of the most critical lifesaving interventions on the battlefield. However, previous studies have shown high failure rates in tourniquet application. Our study aimed to assess the correlation between personality traits that may interfere with effective tourniquet application in a simulated extremity hemorrhage...
January 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29386721/combat-radiology-challenges-and-opportunities
#8
Vivek Sharma, C M Sreedhar, J Debnath
Radiology services in a combat situation are essentially centred on assisting the battle field physicians/surgeons to save/salvage life and limb. Timely and accurate detection of type and mapping of extent of injury can aid in making imaging based triage which can be of immense help to the treating physicians/trauma surgeons. With the availability of rapid assessment (clinical as well as imaging based) and quick transport facility, the focus has gradually been shifting from merely limb-saving to life-saving strategies...
October 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29386717/casualty-air-evacuation-sine-quo-non-of-combat-casualty
#9
C K Ranjan, Piush Renjhen
Management of combat casualties has always been a challenging task. Armed Forces world over have developed effective casualty air evacuation mechanisms. The history of casualty evacuation dates back to 1870s. The first evacuation of casualty by air was during the First World War. The paper highlights the background and evolution of air evacuation in the world and discusses the Indian Scenario of casualty air evacuation. The casualty evacuation capabilities of the aircrafts in the Indian Air Force (IAF) are highlighted...
October 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29386714/forward-surgical-care-emerging-issues-and-challenges
#10
Bipin Puri
War strategies have been evolving with time and battlefield casualty care services have been trying to keep pace with the changing demands. Technological advances in the field of trauma care have revolutionised the way in which erstwhile 'non-salvageable' lives and limbs are managed with more favourable outcome. The quality of Pre-Hospital Trauma Care Services will largely determine the survival statistics of battle casualties. The surgeon has to acknowledge the various resource constraints imposed upon him in the course of delivery of expert trauma care in the battlefield...
October 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29373501/impact-blast-traumatic-brain-injury-implications-for-therapy
#11
REVIEW
Satoshi Yamamoto, Douglas S DeWitt, Donald S Prough
Traumatic brain injury (TBI) is one of the most frequent causes of combat casualties in Operations Iraqi Freedom (OIF), Enduring Freedom (OEF), and New Dawn (OND). Although less common than combat-related blast exposure, there have been significant numbers of blast injuries in civilian populations in the United States. Current United States Department of Defense (DoD) ICD-9 derived diagnoses of TBI in the DoD Health Care System show that, for 2016, severe and moderate TBIs accounted for just 0.7% and 12.9%, respectively, of the total of 13,634 brain injuries, while mild TBIs (mTBIs) accounted for 86% of the total...
January 26, 2018: Molecules: a Journal of Synthetic Chemistry and Natural Product Chemistry
https://www.readbyqxmd.com/read/29370054/staff-officers-as-blood-suppliers-effects-of-repeated-donations-and-autologous-reinfusions-of-untransfused-units
#12
Geir Strandenes, Joar Sivertsen, Håkon Eliassen, Hanne Braathen, Tor A Hervig
BACKGROUND: Limited blood inventory and resupply chains in combat settings can result in preventable deaths from traumatic hemorrhage. One way of mitigating this could be to establish donor pools where blood is collected in advance of high-risk missions and then reinfused back to the donor if not needed to treat casualties. METHODS: 450+56 mL blood was collected, rested for 2 hours in room temperature and stored at 4 °C. The blood was reinfused 22-24 hours after donation and the donor observed for adverse reactions...
January 24, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29370053/a-review-of-the-landscape-challenges-and-gaps-in-trauma-response-to-civilian-high-threat-mass-casualty-incidents
#13
David W Callaway
The ultimate goal of the emergency response and trauma system is to reduce potentially preventable death from trauma. Tremendous advances in trauma care emerged from the past fifteen years of United States' combat engagements around the globe. Unfortunately, combat and insurgency tactics have also metastasized to the civilian world, resulting in increasingly complex and dynamic acts of intentional mass violence. These high threat Active Violent Incidents (AVIs) pose significant preparedness, response and clinical care challenges to the civilian healthcare systems...
January 24, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29365167/refining-the-trauma-and-injury-severity-score-triss-to-measure-the-performance-of-the-uk-combat-casualty-care-system
#14
Jowan G Penn-Barwell, Jon R B Bishop, Mark J Midwinter
Introduction: The Trauma and Injury Severity Score (TRISS) methodology is used in both the UK and US Military trauma registries. The method relies on dividing casualties according to mechanism, penetrating or blunt, and uses different weighting coefficients accordingly. The UK Military Joint Theatre Trauma Registry uses the original coefficients devised in 1987, whereas the US military registry uses updated civilian coefficients, but it is not clear how either registry analyzes explosive casualties according to the TRISS methodology...
January 22, 2018: Military Medicine
https://www.readbyqxmd.com/read/29334570/the-effect-of-prehospital-transport-time-injury-severity-and-blood-transfusion-on-survival-of-us-military-casualties-in-iraq
#15
Russ S Kotwal, Laura L F Scott, Jud C Janak, Bruce W Tarpey, Jeffrey T Howard, Edward L Mazuchowski, Frank K Butler, Stacy A Shackelford, Jennifer M Gurney, Zsolt T Stockinger
BACKGROUND: Reducing time from injury to care can optimize trauma patient outcomes. A previous study of prehospital transport of US military casualties during the Afghanistan conflict demonstrated the importance of time and treatment capability for combat casualty survival. METHODS: A retrospective descriptive analysis was conducted to analyze battlefield data collected on US military combat casualties during the Iraq conflict from March 19, 2003 to August 31, 2010...
January 12, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29307034/emergency-department-imaging-of-pediatric-trauma-patients-during-combat-operations-in-iraq-and-afghanistan
#16
Jason F Naylor, Michael D April, Jamie L Roper, Guyon J Hill, Paul Clark, Steven G Schauer
BACKGROUND: Military hospitals in Iraq and Afghanistan treated children with traumatic injuries during the recent conflicts. Diagnostic imaging is an integral component of trauma management; however, few published data exist on its use in the wartime pediatric population. OBJECTIVE: The authors describe the emergency department (ED) utilization of radiology resources for pediatric trauma patients in Iraq and Afghanistan. MATERIALS AND METHODS: We queried the Department of Defense Trauma Registry (DODTR) for all pediatric patients admitted to military fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016...
January 6, 2018: Pediatric Radiology
https://www.readbyqxmd.com/read/29274254/french-lyophilized-plasma-versus-fresh-frozen-plasma%C3%A2-for-the-initial-management-of-trauma-induced-coagulopathy-a-randomized-open-label-trial
#17
Delphine Garrigue, Anne Godier, Alexandre Glacet, Julien Labreuche, Eric Kipnis, Camille Paris, Alain Duhamel, Eric Resch, Anne Bauters, François Machuron, Pascale Renom, Patrick Goldstein, Benoit Tavernier, Anne Sailliol, Sophie Susen
BACKGROUND: Guidelines recommend to begin haemostatic resuscitation immediately in trauma patients. We aimed to investigate if French Lyophilised Plasma (FLyP) was more effective than Fresh Frozen Plasma (FFP) for the initial management of the trauma-induced-coagulopathy. METHODS: In an open-label, phase 3, randomized trial (NCT02750150), we enrolled adult trauma patients requiring an emergency pack of 4 plasma units within 6 hours of injury. We randomly assigned patients to receive 4-FLyP units or 4-FFP units...
December 23, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/29261592/whole-blood-and-hextend-bookends-of-modern-tactical-combat-casualty-care-field-resuscitation-and-starting-point-for-multi-functional-resuscitation-fluid-development
#18
Forest R Sheppard, Thomas A Mitchell, Antoni R Macko, Darren M Fryer, Leasha J Schaub, Kassandra M Ozuna, Jacob J Glaser
BACKGROUND: Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Pre-hospital resuscitation largely relies on crystalloid and colloid intra-vascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of pre-hospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multi-functional resuscitative fluid development...
December 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29248187/early-transfusion-on-battlefield-before-admission-to-role-2-a-preliminary-observational-study-during-barkhane-operation-in-sahel
#19
V Vitalis, C Carfantan, A Montcriol, S Peyrefitte, A Luft, T Pouget, A Sailliol, S Ausset, E Meaudre, J Bordes
INTRODUCTION: Haemorrage is the leading cause of death after combat related injuries and bleeding management is the cornerstone of management of these casualties. French armed forces are deployed in Barkhane operation in the Sahel-Saharan Strip who represents an immense area. Since this constraint implies evacuation times beyond doctrinal timelines, an institutional decision has been made to deploy blood products on the battlefield and transfuse casualties before role 2 admission if indicated...
November 23, 2017: Injury
https://www.readbyqxmd.com/read/29214626/a-descriptive-analysis-of-data-from-the-department-of-defense-joint-trauma-system-prehospital-trauma-registry
#20
Stephen G Schauer, Michael D April, Jason F Naylor, Joshua J Oliver, Cord W Cunningham, Andrew D Fisher, Russ S Kotwal
The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. The chaos of the prehospital combat setting has led to limitations in the availability of data for performance improvement and research. The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR)...
October 2017: U.S. Army Medical Department Journal
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