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2. Bennett B, Littlejohn L, Kheirabadi B, et al. Manage- hemostatic sponge for temporary internal use. CoTCCC pre-
ment of external hemorrhage in Tactical Combat Casualty sentation; August 2015.
Care: chitosan-based hemostatic gauze dressings—TCCC 23. Food and Drug Administration. FDA clears military trau-
Guidelines-Change 13-05. J Spec Oper Med. 2014;14:40–57. matic wound dressing for use in the civilian population. http://
3. Butler FK, Giebner SD, McSwain N, Pons P, eds. Prehospital www.fda.gov/NewsEvents/Newsroom/PressAnnouncements
trauma life support manual. 8th ed.—military version. Burl- /ucm475810.htm Accessed 8 December 2015.
ington, MA: Jones & Bartlett Learning; 2014. 24. RevMedX. XStat-30 shelf life and testing [letter]. 14 Sept 15.
4. Shina A, Lipsky A, Nadler R, et al. Prehospital use of hemo- 25. Katz A. New hemostatic products squelch bleeding, saving
static dressings by the Israel Defense Forces Medical Corps: lives and limbs. Emerg Med News. 2015;37:1,22–23.
a case series of 122 patients. J Trauma Acute Care. 2015;79: 26. Mueller G, Pineda T, Xie H, et al. A novel sponge-based
S204–209. wound stasis dressing to treat lethal noncompressible hemor-
5. Kotwal RS, Butler FK, Gross KR, et al. Management rhage. J Trauma Acute Care Surg. 2012;73:S134–139.
of junctional hemorrhage in Tactical Combat Casualty 27. Committee on Tactical Combat Casualty Care. TCCC Guide-
Care–proposed change 13-03. J Spec Oper Med. 2013;13: lines 3 June 2015. http://www.tccc-competition.com/tccc
85–93. -guidelines?lang=en. Accessed 19 January 2016.
6. Food and Drug Administration. De novo classification re- 28. Demetriades D, Rabinowitz B, Pezikis A, et al. Subclavian
™
quest for XStat . 2014. http://www.accessdata.fda.gov/cdrh vascular injuries. Br J Surg. 1987;74:1001–1003.
_docs/reviews/k130218.pdf. 29. Iscan S, Etli M, Gursu O, et al. Isolated subclavian vein in-
7. Cestero RF, Song BK. The effect of hemostatic dressings in a jury: a rare and high mortality case. Case Rep Vasc Med.
subclavian artery and vein transection porcine model. Techni- 2013;2013:152762.
cal Report 2013=012. San Antonio, TX; Naval Medical Re- 30. Sondeen J, Coppes VG, Holcomb JB. Blood pressure at which
search Unit San Antonio; 2013. rebleeding occurs after resuscitation in swine with aortic in-
8. Holcomb JB, McMullen NR, Pearse L, et al. Causes of death jury. J Trauma. 2003;54(suppl 5):S110–117.
in Special Operations Forces in the Global War on Terror. 31. Weppner J. Improved mortality from penetrating neck and
Ann Surg. 2007;245:986–991. maxillofacial trauma using Foley catheter balloon tamponade
9. Kelly JF, Ritenhour AE, McLaughlin DF, et al. Injury severity in combat. J Trauma Acute Care Surg. 2013;75:220–224.
and causes of death from Operation Iraqi Freedom and Op- 32. Demetriades D, Chahwan S, Gomez H, et al. Penetrating in-
eration Enduring Freedom: 2003–2004 vs 2006. J Trauma. juries to the subclavian and axillary vessels. J Am Coll Surg.
2008;64:S21–26. 1999;188:290–295.
10. Butler FK, Hagmann J, Butler EG. Tactical combat casu- 33. Tricoci P, Allen J, Kramer J, et al. Scientific evidence un-
alty care in special operations. Mil Med. 1996;161(suppl): derlying the ACC/AHA clinical practice guidelines. JAMA.
3–16. 2009;301:831–841.
11. Butler FK. The US Military experience with tourniquets and
hemostatic dressings in the Afghanistan and Iraq conflicts.
Bull Am Coll Surg. 2015;100:60–65.
12. Holcomb JB, Butler FK, Rhee P. Hemorrhage control devices:
tourniquets and hemostatic dressings. Bull Am Coll Surg. SGM Sims serves as the Medical Research Development Test
2015:100(September suppl):66–71. and Evaluation SGM in the USASOC Combat Development
13. Butler FK, Blackbourne LH. Battlefield trauma care then and Directorate. He has served 19 years in the US Army and has
now: a decade of tactical combat casualty care. J Trauma
Acute Care Surg. 2012;73:S395–402. been assigned to 3rd Special Forces Group and USASOC.
14. Kragh JF, Aden JK. Gauze vs XStat in wound packing for
hemorrhage control. Am J Emerg Med. 2015:974–976. SGM Bowling serves as the Senior Enlisted Medical Advisor
15. Kragh JF, Walters TJ, Baer DG, et al. Practical use of emer- for the US Special Operations Command. He has served for
gency tourniquets to stop bleeding in major limb trauma. J 26 years and been assigned to USASOC and the 7th Special
Trauma. 2008;64:S38–50. Forces Group.
16. Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emer-
gency tourniquet use to stop bleeding in major limb trauma. MSG (Ret) Montgomery is a retired Ranger Medic/Spe-
Ann Surg. 2009;249:1–7. cial Operations Combat Medic, having served as the Senior
17. Davis J, Satahoo S, Butler F, et al. An analysis of prehospital Enlisted Medical Advisor at USSOCOM and the Regimental
deaths: who can we save? J Trauma Acute Care Surg. 2014;
77:213–218. Senior Medic of the 75th Ranger Regiment for 25 years. He
18. Kragh J, Walters T, Westmoreland T, et al. Tragedy into is currently the Operational Medicine Liaison for the Joint
drama: an American history of tourniquet use in the current Trauma System and Committee on Tactical Combat Casualty
war. J Spec Oper Med. 2013;13:5–25. Care.
19. Caravalho J. Dismounted complex blast injury. Report of the
Army Dismounted Complex Blast Injury Task Force. Fort SFC Dituro is a Special Forces 18D medic. He is currently
Sam Houston, TX: US Army; 18 June 2011:44–47. assigned to USASOC.
20. Conley S, Littlejohn L, Henao J, et al. Control of junc-
tional hemorrhage in a consensus swine model with hemo- Dr Kheirabadi is a principal investigator and a research sci-
static gauze products following minimal training. Mil Med. entist at the US Army Institute of Surgical Research ( USAISR).
2015;180:1189–1195.
21. Shackelford SA, Butler FK, Kragh JF, et al. Optimizing the use He received his PhD degree in Physiology and Biophysics from
of limb tourniquets in Tactical Combat Casualty Care: TCCC Georgetown University in 1981. After a 5-year postdoctoral
Guidelines Change 14-02. J Spec Oper Med. 2015;15:17–31. fellowship at Georgetown Medical School and 16 years of ap-
22. Sims K. Management of junctional hemorrhage in Tactical plied research on tissue and organ preservation and plasma
Combat Casualty Care: use of non-absorbable, expandable, product development at the American Red Cross (Holland
TCCC Guidelines: XStat Sponge for External Hemorrhage 27

