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combat casualty care

Pauline K Park, Jeremy W Cannon, Wen Ye, Lorne H Blackbourne, John B Holcomb, William Beninati, Lena M Napolitano
BACKGROUND: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care. METHODS: This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality...
November 2016: Journal of Trauma and Acute Care Surgery
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
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
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
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
Ian L Valerio, Jennifer M Sabino, Christopher L Dearth
Background: A large volume of service members have sustained complex injuries during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF). These injuries are complicated by contamination with particulate and foreign materials, have high rates of bacterial and/or fungal infections, are often composite-type defects with massive soft tissue wounds, and usually have multisystem involvement. While traditional treatment modalities remain a mainstay for optimal wound care, traditional reconstruction approaches alone may be inadequate to fully address the scope and magnitude of such massive complex wounds...
September 1, 2016: Advances in Wound Care
Jennifer M Sabino, Julia Slater, Ian L Valerio
Scope and Significance: Reconstruction of traumatic injuries requiring tissue transfer begins with aggressive resuscitation and stabilization. Systematic advances in acute casualty care at the point of injury have improved survival and allowed for increasingly complex treatment before definitive reconstruction at tertiary medical facilities outside the combat zone. As a result, the complexity of the limb salvage algorithm has increased over 14 years of combat activities in Iraq and Afghanistan. Problem: Severe poly-extremity trauma in combat casualties has led to a large number of extremity salvage cases...
September 1, 2016: Advances in Wound Care
Heather C Yun, Clinton K Murray, Kenneth J Nelson, Michael J Bosse
Trauma to the extremities is disproportionately represented in casualties of recent conflicts, accounting for >50% of injuries sustained during operations in Iraq and Afghanistan. Infectious complications have been reported in >25% of those evacuated for trauma, and 50% of such patients were treated in the intensive care unit (ICU). Osteomyelitis has been reported in 9% (14% of intensive care unit patients), and deep-wound infection in 27% of type III open-tibia fractures. Infections complicating extremity trauma are frequently caused by multidrug-resistant bacteria and have been demonstrated to lead to failure of limb salvage, unplanned operative take-backs, late amputations, and decreased likelihood of returning to duty...
October 2016: Journal of Orthopaedic Trauma
Kyle N Remick, David G Baer, Todd E Rasmussen
No abstract text is available yet for this article.
November 2016: Journal of Trauma and Acute Care Surgery
Amila Sanjiva Ratnayake, B Samarasinghe, M Bala
PURPOSE: The objective of this study was to characterise the spectrum of peripheral venous injury in the Sri Lankan war theatres, including categorisation of anatomic patterns, mechanism and management of casualties, including short-term results of surgical repair of traumatic venous injuries versus ligation. In addition, the effects and outcome of combined arterial and venous injuries versus arterial injury alone are compared. METHODS: All adults with extremity vascular injuries admitted to a military base hospital during an 8-month period were prospectively recorded and those with a venous injury were analysed...
August 11, 2016: Journal of the Royal Army Medical Corps
Stephen L Barnes, Alex Bukoski, Jeffrey D Kerby, Luis Llerena, John H Armstrong, Catherine Strayhorn
BACKGROUND: Training of emergency procedures is challenging and application is not routine in all health care settings. The debate over simulation as an alternative to live tissue training continues with legislation before Congress to banish live tissue training in the Department of Defense. Little evidence exists to objectify best practice. We sought to evaluate live tissue and simulation-based training practices in 12 life-saving emergency procedures. METHODS: In the study, 742 subjects were randomized to live tissue or simulation-training...
October 2016: Surgery
Elizabeth Bridges, Jennifer J Hatzfeld
OBJECTIVE: To describe the accuracy and precision of noninvasive hemoglobin measurement (SpHb) compared with laboratory or point-of-care Hb, and SpHb ability to trend in seriously injured casualties. METHODS: Observational study in a convenience sample of combat casualties undergoing resuscitation at two US military trauma hospitals in Afghanistan. SpHb was obtained using the Masimo Rainbow SET (Probe Rev E/Radical-7 Pulse CO-Oximeter v Clinically indicated Hb was analyzed with a Coulter or iStat and compared with simultaneous SpHb values...
September 2016: Shock
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
Nehemiah T Liu, José Salinas, Craig A Fenrich, Maria L Serio-Melvin, George C Kramer, Ian R Driscoll, Martin A Schreiber, Leopoldo C Cancio, Kevin K Chung
INTRODUCTION: The depth of burn has been an important factor often overlooked when estimating the total resuscitation fluid needed for early burn care. The goal of this study was to determine the degree to which full thickness (FT) involvement impacted overall 24-hour burn resuscitation volumes. METHODS: We performed a retrospective review of patients admitted to our burn intensive care unit from December 2007 to April 2013, with significant burns who required resuscitation using our computerized decision support system for burn fluid resuscitation...
July 6, 2016: Journal of Trauma and Acute Care Surgery
Jayne R Stevens, Joseph Brennan
PURPOSE OF REVIEW: The purpose of this review is to highlight recent literature related to the initial management and reconstruction of blast injuries to the head and neck. RECENT FINDINGS: An increasing percentage of combat-related injuries are caused by blast trauma. Management of blast trauma over the last 10 years has improved understanding of the unique nature of these injuries and the importance of thoughtful management and reconstruction. Blast trauma is associated with an increased need for definitive airway management...
October 2016: Current Opinion in Otolaryngology & Head and Neck Surgery
Matthew Hannon, Matthew D Tadlock, Ted Melcer, Jay Walker, Jesse Bandle, Kameran Nieses, Michael Galarneau
BACKGROUND: We sought to determine the incidence, risk factors, and time course for deep vein thrombosis and pulmonary embolism (DVT/PE) after combat-related major limb amputations. METHODS: Patients with amputation in Iraq or Afghanistan from 2009 through 2011 were eligible. Details of postinjury care, date of diagnosis of DVT/PE, and injury specific data were collected. Military databases and chart reviews were used. RESULTS: In 366 patients, 103 (28%) had DVT/PE; PE was diagnosed in 59 (16%) and DVT in 59 (16%)...
August 2016: American Journal of Surgery
Casey J Allen, Richard J Straker, Clark R Murray, William M Hannay, Mena M Hanna, Jonathan P Meizoso, Ronald J Manning, Carl I Schulman, Jason M Seery, Kenneth G Proctor
U.S. Army Forward Surgical Teams (FSTs) are elite, multidisciplinary units that are highly mobile, and rapidly deployable. The mission of the FST is to provide resuscitative and damage control surgery for stabilization of life-threatening injuries in austere environments. The Army Trauma Training Center began in 2001 at the University of Miami Ryder Trauma Center under the direction of COL T. E. Knuth, MC USA (Ret.), as a multimodality combination of lectures, laboratory exercises, and clinical experiences that provided the only predeployment mass casualty and clinical trauma training center for all FSTs...
June 2016: Military Medicine
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
David Freel, Bradley J Warr
The Army gleaned many lessons regarding the provision of medical care to casualties during the past 14 years of combat. Using these lessons learned in the Joint Capabilities and Integration Development process and through the analysis of an integrated process action team, the Army recently approved 3 changes to medical organizations that are intended to provide trauma management farther forward on the battlefield. These changes include the substitution of an emergency medicine trained physician and emergency medicine physician assistant (PA) in lieu of a general medical officer and primary care PA within the brigade combat team; reorganization of the forward surgical team into a forward surgical and resuscitative team; and the modularization of the traditional 248 bed combat support hospital...
April 2016: U.S. Army Medical Department Journal
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
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