Page 146 - Journal of Special Operations Medicine - Spring 2015

CoTCCC Meeting

3–4 February 2015
Atlanta, Georgia

Selected Meeting Highlights

Dr Frank Butler; COL Lance Cordoni

3 February 2015 to Combat Gauze. They have not been tested in
the US Army Institute of Surgical Research safety
1. Combat Medic Presentation: SFC Matthew Hoard, a model, but both are chitosan­based products in a
Special Forces medic, discussed a case in Afghanistan gauze format (similar to the previously used Hem­
in 2013 where an RPG­7 round impacted an RG­33 Con dressings) and no adverse events were noted
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armored vehicle and resulted in bilateral lower ex­ as a result of HemCon use during the 4 years that
tremity injuries to a team member. The Junctional it was fielded as the US Army and USSOCOM he­
Emergency Treatment Tool (JETT ) was applied mostatic dressing of choice.
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and was effective at halting the junctional bleeding; b. The recent change in fluid resuscitation from hem­
however, two issues arose. First, the JETT became orrhagic shock in TCCC recommended the fol­
dislodged during patient transfer; second, the receiv­ lowing order of precedence:
ing FST was unfamiliar with the JETT device and cut 1. Whole blood
it off upon patient arrival. The Soldier later died of 2. 1:1:1 RBCs:thawed fresh frozen plasma (FFP):
wounds. platelets
The Abdominal Aortic and Junctional Tourni­ 3. 1:1 RBCs:FFP
quet (AAJT) was also discussed and it was noted 4. Four­way tie: Liquid (never frozen) plasma,
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that the AAJT is now approved for a 4­hour applica­ thawed FFP, reconstituted dried plasma, RBCs
tion, but in testing at the US Army Institute of Sur­ only
gical Research (USAISR), a Combat Ready Clamp 8. Hextend
(CRoC ) applied at the umbilicus in order to occlude 9. Lactated Ringer’s or Plasma­Lyte A
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flow in the distal abdominal aorta (analogous to the c. Damage Control Resuscitation, as developed
AAJT) for 2 hours resulted in muscle necrosis and by the US Army Institute of Surgical Research
bowel ischemia. Application of the AAJT also results (USAISR) and implemented by the DoD’s Joint
in significant pain (as do extremity tourniquets) and Trauma System (JTS), has been definitively proven
is difficult for a casualty to tolerate. to save lives. Efforts to expand prehospital blood
product use should be continued and expanded.
2. TCCC Update: CAPT (Ret) Frank Butler, Chairman d. Normal saline (NS) is NOT recommended due to
of the CoTCCC, provided a review of recent changes studies showing that NS is associated with hyper­
to the TCCC Guidelines and other current TCCC chloremic metabolic acidosis.
issues. e. Tourniquets: A 2­hour re­check of tourniquets
a. Combat Gauze remains the first choice for a applied during Care Under Fire or Tactical Field
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hemostatic dressing in TCCC. ChitoGauze and Care to determine if tourniquet removal is feasible
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Celox Gauze are acceptable alternatives if Com­ and hemorrhage control can be maintained with
bat Gauze is not available. These two hemostatic Combat Gauze or other means is now manda­
dressings have been shown to be equal in efficacy tory. This does not replace the frequent re­checks

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