Page 166 - Journal of Special Operations Medicine - Summer 2015

O whole-blood transfusion program for use on the battlefield. JTS/AFMES Combat Fatality Reviews:
Using only prescreened donors known to be low-titer Group Lt Col Ed Mazuchowski
O minimizes the likelihood of the most significant compli-
cation of prehospital whole-blood administration, an ABO- Lt Col Mazuchowski, director of the Office of the Armed
incompatible transfusion. Forces Medical Examiner discussed the history and the present
structure and function of the Armed Forces Medical Exam-
iner System (AFMES). AFMES is making significant contribu-
Proposed Change: AAJT: COL Samual Sauer tions to combat casualty care through such efforts as COL
Ted Harcke’s 2007 paper on the implications of observed
COL Sauer, Dean of Graduate Medical Education at the US chest wall thickness for the length of the needle to be used
Army School of Aerospace Medicine, discussed a proposed for decompression of suspected tension pneumothoraces; the
change to the TCCC Guidelines to recommend the use of the “Feedback to the Field” program: AFMES reports on autopsy
AAJT. Advantages of the AAJT include:
findings, which have significant implications for Combat Ca-
sualty Care providers and the ongoing AFMES/JTS review of
a. The AAJT is the only device to have an approved indi- combat fatalities to determine the specific causes of death and
cation for bleeding in the pelvis, which may accompany whether or not the injuries observed were inevitably fatal or
lower extremity junctional bleeding. potentially survivable.
b. Pelvic hemorrhage, whether blunt or penetrating, is a com-
mon cause of morbidity and mortality in multiple settings.
c. The AAJT has a lower profile and it easier to handle dur- Joint First Aid Kit: CDR Rick Zeber
ing casualty transport than other options for junctional
hemorrhage control. CDR Zeber from Defense Health Agency Medical Logistics
d. Pelvic stabilization has not been definitively shown to de- (DHA-MEDLOG) provided an update on the Joint First Aid
crease hemorrhage in pelvic fractures, but the AAJT is rec- Kit (JFAK). The working group for this project has identified
ognized by the Food and Drug Administration (FDA) to and agreed upon the contents of the JFAK and the Air Force
stabilize pelvic fractures. has an order pending for 9,000 of the new JFAKs. Naval Forms
e. The AAJT is the only device to not show the return of arte- Online is the lead print office for the New DD 1380 TCCC
rial flow through collateral blood flow within 60 seconds. Card and interested parties can find it there by searching for
f. The AAJT is the only device to date that has actually saved “DD 1380.” The Revision date for the form is June 2014.
human life through use at both upper and lower junctional
bleeding sites. New Business:
g. The AAJT is the only device with human research that Dr Frank Butler and Dr David Marcozzi
supports its safety and efficacy at each of its application
sites. Why use any device that has not been tested on live Dr Butler and Dr Marcozzi (LTC, USAR) discussed the transla-
humans for safety and efficacy? tion of military trauma care lessons learned into civilian prac-
tice. A pending publication will show that 86% of US trauma
Potential concerns with the AAJT include: centers that responded to a recent survey use damage control
resuscitation guidelines, but only 20% use tourniquets. A re-
a. The potential for pulmonary compromise. Pressure on the cent case from San Diego, California, was discussed in which
abdomen may create a restrictive physiology; however, one a former Navy Corpsman applied a field expedient tourniquet
published case noted improved end-tidal carbon dioxide to a motorcycle accident victim who had suffered a traumatic
and oxygenation after application of the AAJT in a combat amputation. The tourniquet stopped the hemorrhage, but was
casualty with bilateral lower extremity amputations. Umbil- subsequently removed when a 911 operator instructed the
ical application of the AAJT eliminates aortic blood flow to caller to do so. The patient then expired due to his renewed
distal vascular beds and may provide hemodynamic benefits blood loss. This incident highlights the need to expedite the
through increasing perfusion of the brain, heart, and lungs. transition of lessons learned in prehospital trauma care from
b. Bowel ischemia. This has not been adequately researched, Afghanistan and Iraq into the civilian sector, and ways in which
but COL Sauer pointed out that death from uncontrolled this might be accomplished were discussed by the group.
hemorrhage is also bad for the bowel. Animal studies
showing tissue necrosis with umbilical application of the The National Association of Emergency Medical Techni-
CRoC for 2 hours may not be relevant, due to markedly cians (NAEMT) uses the JTS-developed TCCC curriculum
different tissue pressures. and teaches TCCC provider and instructor courses, which
c. Acute kidney injury. This potential concern has also not are certification card-producing courses. These courses have
been well researched but a periumbilical AAJT application been taught all over the United States and in 20 other nations
that compresses the aorta below the level of the renal arter- around the world. There was strong agreement from the group
ies would theoretically increase renal perfusion pressure. that the DoD should require military medical physicians, phy-
d. Pain from AAJT application can be treated with TCCC- sician assistants, and Combat medical providers to obtain
recommended analgesic agents. TCCC certification, just as we do with other medical courses
such as Advanced Cardiac Life Support, which have less ap-
A number of case reports and laboratory studies were reviewed plicability to battlefield trauma care than TCCC. This certifi-
and discussed. A change paper proposing the incorporation of cation should be renewed every 2 years. NAEMT also teaches
this device into the TCCC Guidelines is being prepared. the TCCC-inspired but civilian-oriented Tactical Emergency

156 Journal of Special Operations Medicine Volume 15, Edition 2/Summer 2015