Combat & Casualty Care

Q1 2017

Military Magazines in the United States and Canada, Covering Combat and Casualty Care, first responders, rescue and medical products programs and news\Tactical Defense Media

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C&CC: From today's U.S. Army Institute of Surgical Research (USAISR) viewpoint on the most effective methodology for addressing hemorrhage mitigation techniques from point of injury to medevac to facility treatment, please provide some insight into the evolution of bleed out stoppage for positive long-term outcomes. Dr. Dubick: It has been reported repeatedly that hemorrhage accounts for about 50 percent of deaths on the battlefield in conventional warfare. In addition, a retrospective evaluation of pre-hospital deaths in Operations Iraqi Freedom and Enduring Freedom found that approximately 24 percent of hemorrhage deaths were potentially survivable with appropriate first aid. Of these potentially survivable injuries, nearly 33 percent involved junctional and peripheral extremities (19.2 percent junctional and 13.5 percent arms and legs). Based on research in our laboratory that suggests every drop of blood counts, rapid hemorrhage control is essential for improving survivability of the casualty. After years of laboratory studies and observational studies of combat casualties, the Committee on Tactical Combat Casualty Care (CoTCCC) has recommended several hemorrhage control devices to stop life-threatening bleeding and prevent the casualty from going into shock. These include the CAT tourniquet for injuries to the extremities, Combat Gauze, Celox Gauze and Chitogauze as hemostatic dressings for external application, and the Combat Ready Clamp, JETT and SAM junctional tourniquets to control bleeding at the groin or axilla areas where standard limb tourniquets cannot be applied. Of the junctional tourniquets, the Army Combat Developer has recommended the SAM junctional tourniquet for inclusion in the sets, kits and outfits. In addition, another junctional tourniquet, the Abdominal Aorta and Junctional Tourniquet is FDA-cleared for use around the umbilicus as well as junctional areas. Also X-stat hemostatic sponges in two applicator sizes are available and approved for junctional wounds. All these devices have been shown to be safe and effective when used as recommended by the manufacturer. In addition, several other hemorrhage control devices have been developed and are available, but have not been recommended by CoTCCC. These include several new tourniquets and the iTClamp approved for temporary control of bleeding in the extremities, axilla, groin, scalp and neck. Another product, the Air Wrap, is essentially an ace wrap with a bladder that may have utility as a hemorrhage control device in junctional and extremity regions of the body. The take home message is that the recommended devices should be applied safely as early as possible and they are all for temporary control of severe bleeding until the casualty can get to a Medical Treatment Facility. C&CC: In terms of maximizing positive pre-surgical condition post- hemorrhage, speak to scenarios that raise the likelihood of patient operability when arriving in facility. Dr. Dubick: As mentioned before, the medical and scientific literature implies that keeping the casualty from going into shock is key to their survivability. The tourniquets and hemostatic dressings mentioned are important to that aim, but injuries do occur where these devices may not be placed. For example, an epidemiological Dr. Michael Dubick Combat & Casualty Care had the opportunity to speak with Michael Dubick, Ph.D., FCCM, Chief of the Damage Control Resuscitation Research Program at the U.S. Army Institute of Surgical Research (USAISR), Ft. Sam Houston, TX, regarding current focal areas for addressing hemorrhage mitigation through better understanding of blood coagulation. Interview conducted by C&CC Editor Kevin Hunter MAXIMIZING BLEED MITIGATION Staff Sgt. Christopher Gonzales and Sgt. John Parmer, members of the California National Guard Counterdrug Task Force ground tactical team, treat a head wound during the practical exercise portion of the Combat Lifesaver course in Sacramento. 22 members of the task force completed the two-day course, which included training in the fundamentals of trauma treatment such as hemorrhage control, opening and maintaining an airway, and treating injuries. (CA Nat. Guard photo) 12 | Combat & Casualty Care | Spring 2017

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