Page 27 - Journal of Special Operations Medicine - Winter 2015

facilities under fluouroscopic guidance, with modifica- soon as possible. Attention should also be directed to-
tions, the device might be feasible for use by prehospital ward determining the injury patterns and physiologic in-
medical providers. dicators that identify the casualties most likely to benefit
from these interventions and application strategies that
The AAJT can be used at junctional sites but is also optimize this potential benefit. These devices should be
cleared by the FDA for abdominal application, in which evaluated, as appropriate, on animal models, and then
configuration it controls distal hemorrhage by occlud- transitioned to clinical use with careful monitoring of
ing the aorta at the level of its bifurcation, distal to the outcomes and further adjustments made based on initial
level of the renal arteries. This eliminates flow to distal clinical experience.
abdominal, pelvic, and lower-extremity vessels.
9. (Tie) Gather information from Combat medics,
In the ResQFoam technology being developed jointly by corpsmen, and PJs regarding the efficacy of all of the
™
the DoD and DARPA in their Wound Stasis program, two hemostatic devices and dressings that they have person-
precursor materials are mixed and then injected percutane- ally used to treat combat injuries on the battlefield. The
ously into the peritoneal cavity to control intra- abdominal TCCC Equipment Feedback project, conducted by the
hemorrhage (Figure 9). The foam mixture expands to ap- Naval Operational Medical Lessons Learned Center
proximately 35 times its original volume and, in doing so, (NOMLLC), is the best current model for gathering this
exerts hemostatic pressure on bleeding sites. 72–74 type of information.

Figure 9 Self-expanding polyurethane foam (ResQFoam ; Published reports on the experiences of seasoned
™
Arsenal Medical; http://www.arsenalmedical.com) Combat medics/corpsmen and PJs with the battlefield
components contained in the injection device. trauma care equipment that they carry are remark-
ably lacking in the medical literature, considering that
our nation has been at war for 14 years. Laboratory
testing of such equipment is appropriate and neces-
Photo courtesy Dr. David King of the merits and weaknesses of the equipment item.
sary, but such testing provides an incomplete picture
Such important questions as ease of use, durability,
performance under environmental extremes, common
causes of failure in combat use, and overall suitability
for battlefield use can be answered with more fidelity
The pelvic hemostasis belt is a circumferential device by a systematic collection of input from the medics,
that, when tightened, transmits pressure directly into corpsmen, and PJs who have actually used the device in
the pelvic cavity, thereby reducing hemorrhage. 75 combat conditions.

While some preliminary studies of these options for pre- The NOMLLC conducted an excellent TCCC equip-
hospital use are promising, 73–77 others are cautionary (B. ment after-action evaluation program for several years
Kheirabadi, personal communication, 2015). 78,79 Use of that allowed for quantitative evaluations and specific
relatively invasive hemorrhage control techniques by comments about the merits and/or shortcomings of cur-
Combat medical providers in the prehospital setting is an rently fielded combat medical equipment to be obtained
area of potential concern. The externally applied devices, from individuals with experience in using these items
which do not require arterial vascular access or intraperi- in combat. This program has now unfortunately been
toneal delivery, involve occlusion of the abdominal aorta, discontinued, but should be restarted and continued as
with the potential for untoward events due to ischemia a permanent feature of the DoD military medical lessons
or elevated intra-abdominal pressure. There is also con- learned or combat casualty care research program.
cern that devices that occlude the abdominal aorta may
actually increase the rate of hemorrhage if there is vascu- 9. (Tie) Evaluate the impact of immediate (immediately
lar injury proximal to the site of the occlusion. after wounding) versus delayed (1 hour and 3 hour)
administration of intravenous (IV) TXA on survival in
Considering that there is a great need for interventions noncompressible hemorrhage.
to successfully control intra-abdominal hemorrhage in
TCCC but that all of the devices mentioned above also Hemorrhagic shock is the leading cause of potentially
entail the potential to harm the casualty, determining preventable deaths in US combat casualties. Eastridge
with as much precision as possible the relative merits found that 24% of combat fatalities were potentially
and disadvantages of each of these noncompressible preventable and that most of these deaths occurred in the
hemorrhage control options should be undertaken as prehospital setting. Ninety-one percent of preventable

The Combat Medic Aid Bag: 2025 15