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https://www.readbyqxmd.com/read/28333833/leadership-and-a-casualty-response-system-for-eliminating-preventable-death
#1
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/28318991/bleeding-control-using-hemostatic-dressings-lessons-learned
#2
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/28318990/junctional-hemorrhage-control-for-tactical-combat-casualty-care
#3
REVIEW
Russ S Kotwal, Frank K Butler
During historic, as well as more recent, conflicts, most combat casualties who die from their injuries do so in the prehospital setting. Although many of the injuries incurred by these casualties are nonsurvivable, a number of injuries are still potentially survivable. Of those injuries that are potentially survivable, the majority are truncal, junctional, and extremity hemorrhage. Novel and effective approaches directed toward prehospital hemorrhage control have emerged in recent years, some of which can prove useful in the management of junctional hemorrhage whether in a military or civilian setting...
March 16, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28290925/two-decades-of-saving-lives-on-the-battlefield-tactical-combat-casualty-care-turns-20
#4
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
#5
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/28285482/clinical-image-visual-estimation-of-blood-loss
#6
Benjamin Donham, Robby Frondozo, Michael Petro, Andrew Reynolds, Jonathan Swisher, Ryan M Knight
Military prehospital providers frequently have to make important clinical decisions with only limited objective information and vital signs. Because of this, accurate estimation of blood loss, at the point of injury, can augment any available objective information. Prior studies have shown that individuals significantly overestimate the amount of blood loss when the amount of hemorrhage is small, and they tend to underestimate the amount of blood loss with larger amounts of hemorrhage. Furthermore, the type of surface on which the blood is deposited can impact the visual estimation of the amount of hemorrhage...
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
#7
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/28280651/prehospital-systolic-hypertension-and-outcomes-in-patients-with-spontaneous-intracerebral-hemorrhage
#8
Stacy Hatcher, Connie Chen, Prasanthi Govindarajan
BACKGROUND: It is well known that hematoma volume and expansion is associated with poor outcomes in patients with spontaneous intracerebral hemorrhage (sICH). The factors associated with hematoma volume and possible expansion include the use of anticoagulant medications, autoimmune or bacterial diseases that reduce platelet production, and genetic defects of Von Willebrand factor causing inhibition or reduction of platelet aggregation. However, little is known about the role of elevated systolic blood pressure (SBP) on hematoma volume and its ultimate role on sICH when identified in the prehospital setting...
January 26, 2017: Curēus
https://www.readbyqxmd.com/read/28257392/prehospital-hypertonic-fluid-resuscitation-for-trauma-patients-a-systematic-review-and-meta-analysis
#9
Claire de Crescenzo, Farzam Gorouhi, Edgardo S Salcedo, Joseph M Galante
BACKGROUND: Prehospital assessment of a patient's circulation status and appropriate resuscitation with intravenous fluids plays a critical role in patients with obvious hemorrhage or systolic blood pressure below 90 mmHg. OBJECTIVES: We assessed the efficacy and safety of prehospital administration of crystalloids, or colloids to improve the survival rate of trauma patients with acceptable safety profile. DATA SOURCES: We searched SCOPUS, Embase, TRIP database, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and PubMed as per search protocol from 1 January 1900 to 12 February 2015...
March 2, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28255632/population-based-autopsy-study-of-traumatic-fatalities
#10
S Saar, A Lomp, J Laos, V Mihnovitš, R Šalkauskas, T Lustenberger, M Väli, U Lepner, P Talving
BACKGROUND: Injuries result in 5.8 million global fatalities annually and are the leading cause of death in younger individuals. Nevertheless, population-based autopsy investigations on traumatic deaths are scarce. We set out to study all consecutive autopsies on traumatic fatalities performed in a 5-year time segment in Estonia. METHODS: After the ethics review board approval, all consecutive autopsies after blunt or penetrating deaths occurring in prehospital or in-hospital settings between January 1, 2009, and December 31, 2013, were retrospectively reviewed using the National Forensic Medicine Database...
March 2, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28245880/pre-hospital-ct-diagnosis-of-subarachnoid-hemorrhage
#11
Maren Ranhoff Hov, Annette Ryen, Katrine Finsnes, Janne Storflor, Thomas Lindner, Jostein Gleditsch, Christian Georg Lund
BACKGROUND: Subarachnoid hemorrhage (SAH) is associated with higher mortality in the acute phase than other stroke types. There is a particular risk of early and devastating re-bleeding. Patients therefore need urgent assessment in a neurosurgical department, and the shorter the time from symptom onset to diagnosis the better. CASE PRESENTATION: The Norwegian Acute Stroke Pre-hospital Project (NASPP) has developed a Mobile Stroke Unit (MSU) model, which is staffed with anesthesiologists also trained in pre-hospital clinical assessment of acute stroke patients and interpretation of computerized tomography (CT)...
February 28, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28238499/out-of-hospital-triage-of-older-adults-with-head-injury-a-retrospective-study-of-the-effect-of-adding-anticoagulation-or-antiplatelet-medication-use-as-a-criterion
#12
Daniel K Nishijima, Samuel D Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R Elms, Roel D Farrales, Calvin Howard, James Montoya, Jeneita M Bell, Mark Faul, David R Vinson, Hernando Garzon, James F Holmes, Dustin W Ballard
STUDY OBJECTIVE: Field triage guidelines recommend that emergency medical services (EMS) providers consider transport of head-injured older adults with anticoagulation use to trauma centers. However, the triage patterns and the incidence of intracranial hemorrhage or neurosurgery in these patients are unknown. Our objective is to describe the characteristics and outcomes of older adults with head trauma who are transported by EMS, particularly for patients who do not meet physiologic, anatomic, or mechanism-of-injury (steps 1 to 3) field triage criteria but are receiving anticoagulant or antiplatelet medications...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28159434/-and-if-it-happened-to-children-adapting-medical-care-during-terrorist-attacks-with-multiple-pediatric-victims
#13
L Alix-Séguin, N Lodé, G Orliaguet, E Chamorro, F Kerroué, C Lorge, A Moreira
In light of the recent terrorist attacks in Europe, we need to reconsider the organization of rescue and medical management and plan for an attack involving multiple pediatric victims. To ensure quick surgical management, but also to minimize risk for on-site teams (direct threats from secondary terrorist attacks targeting deployed emergency services), it is crucial to evacuate patients in a swift but orderly fashion. Children are vulnerable targets in terrorist attacks. Their anatomical and physiological characteristics make it likely that pediatric victims will suffer more brain injuries and require more, often advanced, airway management...
January 31, 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28087807/field-validation-of-the-los-angeles-motor-scale-as-a-tool-for-paramedic-assessment-of-stroke-severity
#14
Joon-Tae Kim, Pil-Wook Chung, Sidney Starkman, Nerses Sanossian, Samuel J Stratton, Marc Eckstein, Frank D Pratt, Robin Conwit, David S Liebeskind, Latisha Sharma, Lucas Restrepo, May-Kim Tenser, Miguel Valdes-Sueiras, Jeffrey Gornbein, Scott Hamilton, Jeffrey L Saver
BACKGROUND AND PURPOSE: The Los Angeles Motor Scale (LAMS) is a 3-item, 0- to 10-point motor stroke-deficit scale developed for prehospital use. We assessed the convergent, divergent, and predictive validity of the LAMS when performed by paramedics in the field at multiple sites in a large and diverse geographic region. METHODS: We analyzed early assessment and outcome data prospectively gathered in the FAST-MAG trial (Field Administration of Stroke Therapy-Magnesium phase 3) among patients with acute cerebrovascular disease (cerebral ischemia and intracranial hemorrhage) within 2 hours of onset, transported by 315 ambulances to 60 receiving hospitals...
February 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27973670/fixed-distance-model-for-balloon-placement-during-fluoroscopy-free-resuscitative-endovascular-balloon-occlusion-of-the-aorta-in-a-civilian-population
#15
Pierre Pezy, Alexandros N Flaris, Nicolas J Prat, François Cotton, Peter W Lundberg, Jean-Louis Caillot, Jean-Stéphane David, Eric J Voiglio
Importance: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an innovative procedure in the treatment of noncompressible truncal hemorrhage. However, readily available fluoroscopy remains a limiting factor in its widespread implementation. Several methods have been proposed to perform REBOA without fluoroscopic guidance, and these methods were adapted predominantly from the military theater. Objective: To develop a method for performing REBOA in a civilian population using a standardized distance from a set point of entry...
December 14, 2016: JAMA Surgery
https://www.readbyqxmd.com/read/27951536/glial-fibrillary-acidic-protein-for-prehospital-diagnosis-of-intracerebral-hemorrhage
#16
Michal Rozanski, Carolin Waldschmidt, Alexander Kunz, Ulrike Grittner, Martin Ebinger, Matthias Wendt, Benjamin Winter, Kerstin Bollweg, Kersten Villringer, Jochen B Fiebach, Heinrich J Audebert
BACKGROUND: Both, acute ischemic stroke (AIS) and hemorrhage stroke (intracerebral hemorrhage, ICH) require early attention but different treatment strategies. Plasma glial fibrillary acidic protein (GFAP) levels were found to be elevated in ICH patients after they arrived in the hospital. Because treatment options differed, we sought to determine whether GFAP can be used to accurately differentiate between of AIS and ICH in the prehospital setting. METHODS: We assessed acute stroke patients in the Stroke Emergency Mobile (STEMO)...
2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/27918852/anomaly-detection-outperforms-logistic-regression-in-predicting-outcomes-in-trauma-patients
#17
Zachary D W Dezman, Chen Gao, Shiming Yang, Peter Hu, Li Yao, Hsiao-Chi Li, Chein-I Chang, Colin Mackenzie
OBJECTIVE: Recent advancements in trauma resuscitation have shown a great benefit of early identification and control of hemorrhage, which is the most common cause of death in injured patients. We introduce a new analytical approach, anomaly detection (AD), as an alternative method to the traditional logistic regression (LR) method in predicting which injured patients receive transfusions, intensive care, and other interventions. METHODS: We abstracted routinely collected prehospital vital sign data from patient records (adult patients who survived more than 15 minutes after being directly admitted to a level 1 trauma center)...
March 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27871682/factors-affecting-mortality-after-penetrating-cardiac-injuries-10-year-experience-at-urban-level-i-trauma-center
#18
Michael J Mina, Rashi Jhunjhunwala, Rondi B Gelbard, Stacy D Dougherty, Jacquelyn S Carr, Christopher J Dente, Jeffrey M Nicholas, Amy D Wyrzykowski, Jeffrey P Salomone, Gary A Vercruysse, David V Feliciano, Bryan C Morse
BACKGROUND: Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. METHODS: From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. RESULTS: Over the 10-year study, 80 PCI patients survived to reach the hospital...
October 15, 2016: American Journal of Surgery
https://www.readbyqxmd.com/read/27846895/development-and-validation-of-a-prehospital-prediction-model-for-acute-traumatic-coagulopathy
#19
Ithan D Peltan, Ali Rowhani-Rahbar, Lisa K Vande Vusse, Ellen Caldwell, Thomas D Rea, Ronald V Maier, Timothy R Watkins
BACKGROUND: Acute traumatic coagulopathy (ATC) is a syndrome of early, endogenous clotting dysfunction that afflicts up to 30% of severely injured patients, signaling an increased likelihood of all-cause and hemorrhage-associated mortality. To aid identification of patients within the likely therapeutic window for ATC and facilitate study of its mechanisms and targeted treatment, we developed and validated a prehospital ATC prediction model. METHODS: Construction of a parsimonious multivariable logistic regression model predicting ATC - defined as an admission international normalized ratio >1...
November 16, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27836253/bi-manual-proximal-external-aortic-compression-after-major-abdominal-pelvic-trauma-and-during-ambulance-transfer-a-simulation-study
#20
M J Douma, D O'Dochartaigh, P G Brindley
BACKGROUND: Applying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion...
January 2017: Injury
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