Page 126 - Journal of Special Operations Medicine - Summer 2014

deployed JTTS prehospital care director. He oversaw Proposed Changes to the TCCC Guidelines
the implementation of the updated TCCC Casualty Three proposed changes to the TCCC Guidelines were pre-
Card and electronic TCCC AAR in theater; his efforts sented at the meeting. All of these changes are supported
resulted in the submission of more than 300 AARs—a by position papers that have been prepared for presenta-
remarkable success in prehospital care documentation.
tion to the TCCC Working Group and will be forwarded
to the group before the CoTCCC votes on them.
LTC Geracci also personally trained more than 1100
medics, corpsmen, and pararescuemen (PJs) in the use 1) Dr. Brad Bennett and CDR Lanny Littlejohn proposed
of junctional tourniquets and documented 8 uses of a change to add Celox Gauze and ChitoGauze to
™
®
the JETT device on combat casualties. All were judged Combat Gauze as CoTCCC-recommended hemo-
™
successful at controlling the junctional hemorrhage, al- static agents, although Combat Gauze would remain
though two of the casualties later died.
the hemostatic dressing of choice.
®
LTC Geracci noted that the SAM Junctional Tourni- 2) LTC Bob Mabry proposed that surgical airways be
quet was the clear favorite among the junctional devices performed using the CricKey—a device that com-
(CRoC, JETT, SAM, and AAT) of the overwhelming bines a customized bougie and a cuffed Melker air-
majority of medical personnel that he trained in theater. way. LTC Mabry’s surgical airway study published
in the Annals of Emergency Medicine in 2013 com-
A final point of emphasis was that for casualty survival pared airways performed with the CricKey to air-
on the battlefield to be maximized, line commanders at ways performed using the standard open surgical
all levels must take ownership of this aspect of combat airway technique. In a prospective, crossover study
operations and make caring for wounded unit members with the surgical airways that were all performed by
part of their unit’s warrior culture. combat medics, the CricKey technique resulted in sig-
nificantly faster insertion times.
JTTS Prehospital Care Director’s Report
3) Dr. Frank Butler outlined a proposed change to fluid
COL Samual Sauer resuscitation in TCCC that incorporates dried plasma
as an option for prehospital fluid resuscitation and
COL Sauer from the U.S. Army School of Aviation Medi- provides a ranking of the prehospital resuscitation
cine presented his perspectives after a tour as the deployed fluid options.
JTTS prehospital director. He reviewed one aspect of care
that illustrates the difficulty of overcoming organizational These three changes were discussed at length. The word-
inertia. Despite a consensus opinion by the ophthalmol- ing for the proposed changes will be modified based on
ogy and the TCCC communities that known or suspected feedback received at the meeting and the changes pre-
penetrating eye injuries should be treated with a rigid eye sented to the CoTCCC for a vote in the near future.
shield, no topical medications, systemic antibiotics, and
immediate evacuation, there is still support for the mis-
guided and harmful approach of placing topical antibiot- Far­Forward Blood and Plasma
ics in the injured eye and pressure patching it.
Dr. Phil Spinella
COL Sauer cited a list of doctrinal documents that con- Dr. Spinella and CDR Geir Strandenes co-direct the
tain this erroneous guidance and noted that the DoD Trauma Hemorrhage and Oxygenation Research
still fields an eye injury treatment kit that contains all (THOR) working group. THOR has 150 members from
of the equipment (accompanied by directions) required 11 countries, and its mission is “To improve survival
to provide this inappropriate care. As a result of this from hemorrhagic shock for patients with traumatic
failure to effectively train and equip the force to manage injuries by improving identification and treatment of
this type of injury, a significant number (60%) of U.S. shock and coagulopathy in the pre-hospital setting.”
casualties have not received appropriate care for their
penetrating eye trauma. Dr. Spinella observed that blood products provide better
resuscitation from shock than either crystalloids or col-
COL Sauer also pointed out that, after 13 years of re- loids and that this difference will be more pronounced
markable success in treating life-threatening extremity in future conflicts where evacuation times are longer
hemorrhage with aggressive use of tourniquets to gain than the very short evacuation times currently seen in
initial control of the hemorrhage, the Army Expert Field Afghanistan. He outlined the present gaps in evidence
Medical Badge handbook still describes tourniquets as a that must be addressed to increase the availability of
treatment of “last resort.” lifesaving blood products in the prehospital setting and

116 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014