Page 9 - JSOM Winter 2025

Implementing Operational Skills in the Education of Com- ONGOING SERIES
bat Medics at the Belgian Defense: An Integrative Model: PROLONGED CASUALTY CARE
Waroquier and colleagues compare final theoretical and prac- Maritime Applications of Prolonged Casualty Care Training
tical results between EMT and non-EMT candidates (n=137) Scenario: Burn Injury on a Destroyer During Distributed Mar-
in the Belgian Defense’s combat medic certification program. itime Operations: Adams and colleagues present an innovative
These results showed that clinically exposed (EMT) candidates approach to teaching complex operational medicine concepts
did not demonstrate superiority in any domains or subdomains (including Prolonged Casualty Care) to austere Role 1 mari-
when compared to their non-EMT peers. Non-EMT candi- time caregivers using a hypothetical scenario involving a pa-
dates, mainly from the Belgian Special Operation Regiment, ex- tient with severe burn injury of the torso with circumferential
hibited equal theoretical and practical results when compared upper extremity after a transformer exploded in a confined
to EMT candidates. Certain course parameters may account space while he was working on the ship’s electrical system.
for why the clinically exposed group did not perform better, but
the role of intrinsic motivation and situational awareness in the THE WORLD OF SPECIAL OPERATIONS MEDICINE
clinically-naive group warrants further investigation. Dig Deep! The Sub-Terranean Casualty Stabilization Points:
Miles and colleagues explore the adaptation of medical sup-
IN BRIEF port in static warfare, focusing on the development of Subter-
“Ruck-Truck-House-Plane” Plan Application for the Manage- ranean Casualty Stabilization Points (ST CSP) by the Armed
ment of Combat-Related Wound Infections and Prevention of Forces of Ukraine. The authors recommend Western militaries
Multidrug-Resistant Organism Spread in Prolonged Field Care consider similar adaptations in future conflicts, as they enable
Scenarios: Pasquier and colleagues introduce a “Ruck-Truck- damage control resuscitation and damage control surgery
House-Plane” model for infection control and wound manage- close to the front lines, significantly reducing the time from
ment in the Prolonged Casualty Care (Role 1) environment and injury to surgery.
beyond. This original approach includes practical procedures
and decision-making from point of injury to tertiary care trans-
fer. It emphasizes early decontamination, phased surgical care,
remote microbial diagnostics, and antimicrobial stewardship to
reduce morbidity and mortality in modern warfare.

CASE REPORT
Infective Endocarditis: Severe Complication from a Common
Procedure: Maurice and colleagues present the case of a 26-
year-old Army Officer with fever, skin lesions, and pain at
his IV site following a recent hospitalization for heat injury
while participating in Special Forces Assessment and Selection.
While infective endocarditis is rare in otherwise healthy sol-
diers, when the tactical setting allows, prehospital providers Operating theatre.
must practice aseptic techniques and advocate for their pa-
tients when other medical providers do not understand the Medical Considerations in High-Risk Maritime Operations: A
potential consequences of the field environment. Narrative Review: In this narrative review of the literature from
2005 to 2024, Granholm and colleagues examine the medical
aspects critical to maritime operations, including hypothermia
management, trauma care in confined and moving spaces, man-
agement of drowning and respiratory issues, and specialized
training for maritime-specific injuries. The authors conclude
Patient’s left antecubital fossa prior that with the increasing demand for maritime missions, con-
to presentation at his local Military tinuously evolving medical practices will be vital to ensuring
Treatment Facility. both operational success and personnel safety. They stress that
future research should not be limited to risk mitigation and core
medical issues but should also investigate ways to maintain or
enhance operator performance in maritime environments.
TCCC UPDATES
EDITORIAL Committee on Tactical Combat Casualty Care (CoTCCC): Po-
Tourniquet Management Beyond the Golden Hour: A Call for sition Statement on Grading of Evidence for Tactical Combat
Doctrinal Change in TCCC: Beerbaum and colleagues argue Casualty Care (TCCC)
that current TCCC doctrine lacks sufficient emphasis on tour- Antibiotics in Tactical Combat Casualty Care 2025: TCCC
niquet reassessment, conversion, and optimization—especially Change 25-1
among non-medical personnel. This paper calls for doctrinal
change to classify tourniquet reassessment, conversion, and Introduction to Tactical Combat Casualty Care: 11 October
optimization as Tier 1 skills. The authors recommend updating 2022
TCCC training, emphasizing reassessment within 2 hours of
application, incorporating tourniquet conversion/optimization 2025 CMC ABSTRACTS
into training lanes, and revising the DD1380 TCCC card to 7th Combat Medical Care Conference, 2 and 3 July 2025
document these interventions.

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