Page 165 - Journal of Special Operations Medicine - Summer 2015

oral formulation is not recommended. Ondansetron has a much sturdier) designed to close skin lacerations and wounds
more favorable side-effect profile than promethazine. and, therefore, promote hemorrhage control. Dr John Hol-
G. The use of tranexamic acid (TXA) to promote hemostasis comb, Dr Don Jenkins, and MSG Curt Conklin also expressed
was discussed at length. The CRASH-2 and MATTERS their support for this device. It was noted to be especially use-
studies showed that early use of TXA can be lifesaving. ful for controlling bleeding from scalp lacerations.
Multiple papers in the orthopedic and spinal surgery
literature have shown that TXA reduces surgical blood There was concern from the group that this device would work
loss without causing an increase in thromboembolic only on linear wounds and perhaps hide bleeding, as opposed
events. Since TXA has been shown to be effective at reduc- to stopping it. Packing a wound with Combat Gauze followed
ing blood loss, it should be used by prehospital care pro- by application of the iTClamp to seal the wound would per-
viders as soon as possible after injury in penetrating torso haps be a more effective approach if the wound morphology is
trauma. Delaying administration of TXA until arrival at a favorable for this approach. A position paper proposing that
medical treatment facility is not supported by the available this device be incorporated into the TCCC Guidelines is being
evidence. prepared.
H. TCCC has been shown to reduce the incidence of prevent-
able deaths in combat casualties, but it has not been im-
plemented evenly throughout the Armed Services and the Far-Forward Blood Product Options:
Geographic Combatant Commands. Having physicians Dr Phil Spinella
who have not been trained in TCCC in the position of su- Dr Spinella, a pediatric intensivist and a recognized expert in
pervising combat medical providers who have been trained transfusion medicine, discussed options for far-forward blood
in TCCC is clearly not optimal. Strategies to mitigate this product administration on the battlefield. Options include
unfavorable situation are being explored by the JTS. whole blood, RBCs, thawed plasma, and freeze-dried plasma.
I. The Army Department of Combat Doctrine Development Dr Spinella believes that whole blood is the simplest and most
®
recently recommended the SAM Junctional Tourniquet effective blood product to use in the prehospital tactical envi-
(SAM Medical Products; www.sammedical.com/products) ronment. He noted that the Royal Caribbean Cruise Line has a
as the Army solution for junctional hemorrhage control. whole-blood transfusion program for use in their ships at sea.
This recommendation was approved by the US Army In a 40-month period, there were 40 emergent whole-blood
Medical Command. transfusions, with patients receiving between 1 and 6 units of
blood. There was one allergic reaction and no infectious com-
Joint Theater Trauma System Prehospital plications in this series. Dr Spinella favors a low-titer Group O
Director Brief: MAJ Neil David strategy for far-forward whole blood transfusions.
MAJ David gave a presentation based on his experience as
the Deployed Prehospital Director for the JTS. He emphasized Far-Forward Fresh Whole Blood/TXA in TCCC:
that there is a need to develop a way to train deployed person- CDR Geir Strandenes
nel on the TCCC updates. He also noted that medics like the CDR Strandenes, from the Norwegian Navy Special Opera-
new TCCC cards (DD 1380s), but that the TCCC cards do not tions unit, also recommends the use of whole blood for resus-
reliably get entered into the casualty’s medical record. MAJ citation from hemorrhagic shock in far-forward environments.
David emphasized that we must train medical treatment facil- His unit uses Group A blood for blood type A recipients and
ity personnel to ask for the casualty’s TCCC card when he or Group O (preferably low titer) blood for all others. He also
she arrives at the facility and to ensure that the information on discussed how this program has been implemented with Nor-
the card is entered into the medical record. wegian Maritime Special Operations. His unit’s program
includes a donor pool of unit personnel, blood donor pre-
Trauma Considerations in Operation United screening, protocols for emergency whole-blood collections,
Assistance: COL Jim Czarnik and a blood administration protocol. CDR Strandenes recom-
mends designating low-titer Group O whole blood as the uni-
COL Czarnik, the Surgeon for Army Forces in the US Africa versal whole blood choice and increasing use of serum lactate
Command, discussed trauma considerations in Operation levels to guide transfusion volume.
United Assistance. He observed that US Military operations in
recent years have been centered on the conflicts in Afghanistan He also recommends re-evaluation of the present strategy for
and Iraq, and that we must now begin to plan and train for using TXA in the US Military: using the mechanism of injury
early entry into much more austere deployed environments, as as a trigger for administration; giving TXA via slow IV push
typified by those in AFRICOM. rather than as a 10-minute infusion; and drawing up doses of
TXA prior to the mission.
Proposed Change: iTClamp: MAJ Kyle Faudree
75th Ranger Regiment Blood Program:
MAJ Faudree, the Regimental Physician Assistant for the MSG Curt Conklin
160th Special Operations Aviation Regiment, discussed the
®
Innovative Trauma Care iTClamp (www.innovativetrauma MSG Conklin, the Senior Medic in the 75th Ranger Regiment,
care.com). This is a small device (similar to a “chip clip” but outlined the Regiment’s plan to implement a low-titer Group

CoTCCC Meeting Minutes 155