Page 151 - Journal of Special Operations Medicine - Fall 2015

A Preventable Death: 2003 Tourniquet Use Early in the
Iraq and Afghanistan Conflicts
This casualty was wounded by an RPG
explosion and sustained a traumatic amputation of the • NOT widely used at the start of the wars
right arm and a right leg wound. He bled to death from
his leg wound despite the placement of three field- • Increased use by both Special Operations and
expedient tourniquets. conventional units beginning in 2005
• NOT evolutionary – a series of discrete events

What could have saved him The Drivers:
CAT Tourniquet • Early reports of success with TCCC, especially TQs
TCCC training for all • Holcomb study: “Causes of SOF Deaths 2001-2004”
unit members • USAISR tourniquet study by Walters et al (2005)
*Note: Medic killed at • USSOCOM TCCC message - March 2005
onset of action • USSOCOM/ISR TCCC Transition Initiative (SFC Greydanus)
• USCENTCOM tourniquet and hemostatic dressing
(HemCon) message 2005

Preventable Combat Deaths TCCC and Hemorrhage
from Not Using Tourniquets

External Non-Compressible
• Maughon – Mil Med 1970: Vietnam Tourniquets AAJT
– 193 of 2,600 Combat Gauze Self-Expanding PU Foam
– 7.4% of total combat fatalities Junctional TQs Pelvic Hemostatic Belt
• Kelly – J Trauma 2008: OEF + OIF (2003/4 and 2006) REBOA

– 77 of 982 (in both cohorts of fatalities)
– 7.8% of total fatalities – no better then Vietnam Both
• Tourniquets became widely used in 2005-2006 Prehospital DCR
• Eastridge – J Trauma 2012: OEF + OIF (to Jun 2011) TXA
Hypothermia Prevention
– 119 of 4,596 Avoidance of NSAIDs
– 2.6% of total fatalities – a 67% decrease Triple-Option Analgesia

TCCC and Airway TCCC and Tension
Pneumothorax

Sit Up and Lean Forward Positioning Revised indications

De-emphasize endotracheal intubation Chest tubes usually not needed

Nasopharyngeal Airways 3.25 “ 14-gauge catheter

Surgical airways Lateral site

CricKey Bilateral NDC for loss of vital signs prehospital

TCCC Updates 139