Page 8 - JSOM Winter 2025

FEATURE ARTICLES A Prospective Comparison of SAM IO versus EZ-IO Insertion
The Chicken, Fox, and Grain: Solving the Problem of CASEVAC: Time and Usability During Simulated Vascular Access: Stiglitz
Barbee and Causey argue that the U.S. Army’s current casualty and colleagues conducted a randomized prospective trial with
evacuation (CASEVAC) strategy is inadequate for managing 106 EMS clinicians to compare the EZ-IO and SAM IO for
large-scale conflicts, particularly when casualties overwhelm intraosseous (IO) access by examining insertion times and user
evacuation capabilities. They present three concepts and three preferences. The researchers report that the EZ-IO had a faster
recommendations to set conditions for future CASEVAC. insertion time compared to the SAM IO, but the time differ-
Overall, the authors advocate a whole of force approach, ence was unlikely to have any meaningful impact on patient
through which the Army can streamline command and control outcomes. Although participant responses indicated a prefer-
and leverage emerging technology, like artificial intelligence ence for the EZ-IO, most felt confident using the SAM IO—a
and unmanned autonomous systems, to enhance its capacity less costly and manually powered driver—in an EMS setting.
and capability to evacuate casualties.
Plastic Packaging Wrap for Patient Packaging: In this arti-
cle, Thompson and colleagues describe how plastic packaging
wrap (i.e., Saran wrap, cling film, cling wrap, or Glad wrap) Arrow EZ-IO and
can be used for medical purposes in austere, remote, and tac- SAM IO drivers and
tical environments. This wrap can be used for burn coverage, needles.
splinting, bowel evisceration, and casualty card fixation, as
well as substitute for pressure dressings, endotracheal tube
ties, improvised pressure infusers, improvised pneumatic tour-
niquets, and head immobilizers. While not a replacement for
commercially available, approved products, packaging wrap Low-Tech Solutions for Military Prehospital Medication Stor-
can be a valuable tool in austere environments, where space age in Arctic Circumstances: A Feasibility Study: Fransen
and weight are limited. and colleagues sought to demonstrate the feasibility of stor-
ing medication within controlled parameters by a lightweight,
highly mobile, solution at a Role 1 Medical Treatment Facility
during cold-weather operations. Within a standard cooling
container, they placed three 1L water bottles filled with boiling
Creation of endotracheal water, which were reheated every morning. Over a period of
tube tie and improvised 264 hours, they measured the inside and outside temperatures
pressure infuser.
of the container. Their data indicated that medication storage
in this manner is still not compliant with current regulations.
However, the temperature had been within the parameters
for controlled temperature for almost 70% of the time. This
10-Gauge versus 14-Gauge Fenestrated Needle / Catheter finding suggests the need for further research on temperature-
Units for Decompression of Tension Pneumothorax in Cadav- controlled medication storage during arctic deployments using
eric Model: Long and colleagues compared 10-gauge (10ga) smaller and better cooling containers and stricter protocols.
and 14-gauge (14ga) fenestrated needle/catheter units for nee- Calcium Supplementation in Tactical Combat Casualty Care:
dle decompression in this non-randomized, non-blinded study De Luca and colleagues examine evidence surrounding the in-
using human cadavers. Tension pneumothorax decompression clusion of calcium in military trauma care protocols. Clinical
success rates were similar between units; however, 10ga units evidence suggests that addressing hypocalcemia early in trauma
achieved this approximately 17 seconds faster. The researchers resuscitation via calcium administration can significantly im-
contend that these seconds are potentially lifesaving and rec- prove coagulation efficiency and cardiovascular stability, ulti-
ommend that needle/catheter unit specifications be updated to mately reducing mortality rates—even in the absence of blood
reflect these findings. products. The authors acknowledge that while challenges, such
as dosing protocols and logistical considerations exist, they can
Prehospital Fibrinogen Levels in Major Trauma Patients Trans-
ported by Helicopter Emergency Medical Service Deter- be overcome with proper planning, training, and innovation.
mining Who Might Benefit: To identify prehospital variables
associated with hypofibrinogenemia at emergency department THE ROLE OF CALCIUM IN THE DIAMOND OF DEATH
(ED) arrival, Pretty and colleagues reviewed health records of HYPOTHERMIA:
65 consecutive patients transported by helicopter EMS to two
trauma centers and who received one or more units of packed ACIDOSIS: Diamond
of
red blood cells during transport. The researchers found that Death
persistent hypotension after the first blood transfusion and an
initial ED shock index ≥1.5 predicted which patients devel- HYPOCALCEMIA:
oped low fibrinogen, coagulopathy, and mortality from hem- Calcium and its relationship to individual components of the
orrhage and other causes. traditional lethal triad demonstrated as the diamond of death.

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