Page 167 - Journal of Special Operations Medicine - Summer 2015

Casualty Care, Law Enforcement First Responder, and Bleed- • Central line (right subclavian)
ing Control (B-Con) courses, and these courses are excellent • 5 units of O-positive RBCs
alternatives for organizations that would prefer not to use • Zofran 8mg IV
military-style courses to train their personnel. • Fentanyl 100μg, followed by three additional doses of 50μg
each
4 February 2015 • TXA, 1g
• ANCEF, 2g
Senior Leader Remarks: MG Brian Lein
The unit’s liaison at the NATO Role 3 medical treatment facil-
MG Lein, the Commander of the US Army Medical Research ity at Kandahar Air Field called a week after the injury and
and Materiel Command, outlined his views on TCCC and the informed SSG Talbot that the patient was doing well.
need to bring advanced care far forward. He stated that care
should not be role dependent but rather casualty dependent.
He recalled that the Joint IED Defeat Organization initiative III Corps TCCC Overview: COL Jim Geracci
took lessons learned from real-world improvised explosive de-
vice (IED) events and incorporated them into training at the COL Geracci, the III Corps Surgeon, discussed the time con-
National Training Center within 2 weeks, greatly improving straints that many units face in terms of medical training, and
the response and capabilities of deploying Military units. The stated that TCCC must be integrated into other training events
question was posed: why can’t advances in battlefield trauma as opposed to receiving dedicated time. He discussed that Com-
care be implemented in a similarly expeditious manner? bat Lifesaver (CLS) and first responder-type courses (Ranger
First Responder, Pegasus First Responder, etc.) do not require
MG Lein noted that future battlefields may be urban ones Medics to teach them; rather, noncommissioned officers in lead-
where, as in Mogadishu, we will not be able to land a helicop- ership positions can be trained by medics to conduct CLS and
ter and achieve rapid casualty evacuation. He noted that he first-responder training independently. COL Geracci showed
was happy to see a number of representatives from our coali- data from COL (Ret) Russ Kotwal when he was the 75th Ranger
tion partner nations at the meeting and emphasized the need to Regiment Surgeon, which documented that the incidence of pre-
continue and expand this international partnership dedicated ventable deaths among the Regiment’s combat casualties was
to improving prehospital trauma care. He also discussed the much lower than in the US military as a whole. This decrease in
need to consider new weapons systems and different wound- preventable deaths was attributed to the fact that every Ranger
ing patterns in planning for CCC in possible future conflicts. in the Regiment was trained in TCCC and could perform life-
saving interventions for their wounded buddies.
Finally, MG Lein shared a recent experience with a trauma
victim here in the United States, where the tenets of TCCC and JTS Director Brief: COL Kirby Gross
care we have learned on the battlefields of Iraq and Afghani-
stan were not performed, demonstrating the need to further COL Gross, the JTS Director and the Army Surgeon Gen-
educate all first responders and further awareness on forward eral’s Trauma Consultant, presented an overview of the JTS,
resuscitation techniques. including its inception early in the conflicts in Afghanistan and
Iraq, and its subsequent evolution. Among the many functions
Combat Medic Presentation: SSG Jonathan Talbot performed by the JTS by the end of the recent conflicts were
ownership of the DoD Trauma Registry; a robust CCC perfor-
SSG Talbot, from the 4th Infantry Brigade Combat Team, 4th mance improvement process; predeployment training for Joint
Infantry Division in Fort Carson, Colorado, presented a casu- Theater Trauma System (JTTS) teams; advocacy in the con-
alty scenario in which an Afghan National Army Soldier ar- tiguous United States for the deployed trauma care mission;
rived at a Role 1 Aid Station after having stepped on an IED mentorship of JTTS leaders; ongoing review and update of the
outside of his vehicle. The casualty had suffered a partial am- JTS Clinical Practice Guidelines; and conduct of the weekly,
putation of his right leg and a complete amputation of his left worldwide CCC performance-improvement teleconference.
leg just below the knee. The patient also had multiple ampu-
tated digits on both hands. Point of injury (POI) care consisted
of CAT tourniquets to both lower extremities and his left arm. Proposed Change: XStat: SGM Kyle Sims

On arrival at the Aid Station, the casualty displayed signs of SGM Sims, from the USSOCOM, discussed a new hemostatic
®
hemorrhagic shock. He was alert, but incoherent, and had ab- device, XStat (RevMedX Inc.; www.revmedx.com), which is an
sent radial pulses. His initial vital signs were: blood pressure, injectable chitosan-coated compressed sponge system. The de-
60 mmHg palpable; respiration rate, 10/minute; and heart rate, vice is currently FDA approved only for junctional hemorrhage
154/minute. Aid Station treatment consisted of the following: and only for use on the battlefield. Testing at the Naval Medi-
cal Research Unit, San Antonio, using a porcine bleeding model
• Assessment and reinforcement of initial POI tourniquets of subclavian artery and vein injury, found that XStat could be
• Administration of high-flow oxygen applied in half the time of Combat Gauze (31 seconds versus
• IV access (right arm) 60 seconds) Blood loss was also significantly reduced, although
• Wound packing there was no difference in survival between the XStat group and
• Pressure bandages (all four extremities) the Combat Gauze group in this study. A similar device that is
• Splints placed on both lower extremities chitosan-free and intended for smaller entrance wounds is also

CoTCCC Meeting Minutes 157