Page 148 - Journal of Special Operations Medicine - Spring 2015

8. MSG Curt Conklin, the Senior Medic in the 75th The CRoC animal studies with umbilical appli­
Ranger Regiment outlined the Regiment’s plan to cation may not be relevant due to markedly dif­
implement a low titer type O whole blood transfu­ ferent tissue pressures.
sion program for use on the battlefield. Using only c. Acute kidney injury – Has not been adequately
prescreened donors known to be low titer type O researched, but anatomically, a periumbilical
minimizes the likelihood of the most significant com­ AAJT is compressing the aorta below the level of
plication of prehospital whole blood administration, the renal arteries and would theoretically would
an ABO­incompatible transfusion. increase renal profusion pressure.
d. Pain/discomfort – Can be treated with TCCC
9. COL Samual Sauer discussed a proposed change to recommended analgesia.
the TCCC Guidelines to recommend the use of the
AAJT. Case reports and laboratory studies were reviewed
and discussed. A proposed change paper suggesting the
Advantages of the AAJT include: incorporation of this device into the TCCC Guidelines
a. The AAJT is the only device to have an approved is being prepared.
indication for bleeding in the pelvis, which is a
common complication in lower junctional trauma. 10. Lt Col Ed Mazuchowski, the Director of the Armed
b. Pelvic hemorrhage, whether blunt or penetrating, Forces Medical Examiner System (AFMES), dis­
is a common cause of morbidity and mortality in cussed the history and the present structure and
multiple settings. function of the AFMES. The AFMES is making
c. Pelvic stabilization alone has not been found effec­ significant contributions to combat casualty care
tive to decrease pelvic hemorrhage in penetrating through such efforts as COL Ted Harcke’s 2007
trauma; however, the AAJT is recognized by the paper on the implications of observed chest wall
FDA to stabilize the pelvis. thickness for the length of the needle to be used for
d. It is the only device to not show the return of arte­ decompression of suspected tension pneumothora­
rial flow through collateral blood flow within 60 ces; the “Feedback to the Field” program where
seconds. they report key observations on combat casualty
e. It has a lower profile and is easier to handle during care noted at autopsy; and the ongoing AFMES­
transport than other options for junctional hem­ JTS review of combat fatalities to determine the
orrhage control. specific cause of death and whether the inju­
f. It is the only device to have actually saved human ries observed were inevitably fatal or potentially
life in upper and lower junctional bleeding to date survivable.
g. It is the only device with human research that sup­
ports its safety and efficacy at each of its applica­ 11. CDR Rick Zeber from Defense Health Agency
tions sites. Why use any device that has not been Medical Logistics (DHA­MEDLOG) provided an
tested on live humans for safety and efficacy? update on the Joint First Aid Kit (JFAK). The work­
ing group for this project has identified and agreed
Potential concerns with this device are: upon the contents of the JFAK, and the Air Force
a. The potential for pulmonary compromise. Pres­ has an order pending for 9000 of these kits.
sure on the abdomen may create a restrictive
physiology; however, one published case noted 12. Dr Frank Butler and Dr David Marcozzi (LTC,
improved end­tidal CO and oxygenation after USAR) discussed the translation of military trauma
2
application in a combat casualty with bilateral care lessons learned into civilian practice. A pending
LE amputations. Theoretically, perimbilical ap­ publication will show that 87% of US trauma cen­
plication of the AAJT may markedly reduce the ters use Damage Control Resuscitation guidelines,
perfused intravascular volume with hemodynamic but only 20% use tourniquets. A recent case from
benefits. The remaining blood would have higher San Diego was discussed in which a former Navy
perfusion pressures to vital organs (lungs, heart, Corpsman applied a field expedient tourniquet to
and brain). a motorcycle accident victim who had lost his leg.
b. Bowel ischemia. This has not been adequately re­ The tourniquet stopped the hemorrhage but was re­
searched; however, death from uncontrolled hem­ moved when a 911 operator instructed the caller to
orrhage was also noted to be bad for the bowel. do so. The patient then expired due to blood loss.

138 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015