Page 152 - Journal of Special Operations Medicine - Summer 2016

Committee on Tactical Combat Casualty Care Meeting
2–3 February 2016, Atlanta, Georgia:
Meeting Minutes

TUESDAY, 2 FEBRUARY 2016 • Rapid pain control was achieved with 75mg of ket-
amine given IO.
1. Chairman’s Welcome: Dr Frank Butler convened the • The helicopter landing zone was changed en route to
meeting and welcomed the meeting participants. After facilitate transport of the casualty.
reviewing the agenda, it was noted that there are no • The casualty was well protected from rotorwash as
conflicts of interests among the attendees. the aircraft was landing.
• There were no breaks in communication; this resulted
2. Combat Medic Presentation: SPC Drake Monticelli in a rapid evacuation.
presented an improvised explosive device (IED) scenario.
Lessons learned (“Improves”) from this operation
Casualty #1 was the man who stepped on the IED. He included:
suffered bilateral lower leg amputations. Four SOFT-T • The casualty wasn’t placed in a Hypothermia Preven-
tourniquets were placed high and tight on his legs. The tion & Management Kit until movement to casualty
casualty was alert and oriented. The evacuation helicop- evacuation (CASEVAC) site.
ter landed 42 minutes after the wounding occurred. The • Pelvic stabilization was not performed.
casualty was reported to have received 30 units of blood • Only one fluid resuscitation site was established. On
products at the medical treatment facility. board, the flight medic tried to administer packed
RBCs but only succeeded in pulling out the IO.”
Problems encountered in treatment included: • Antibiotics were not administered.
• Three attempts at intravenous (IV) access and a hu- • TXA administration was attempted but the ampule
meral head intraosseous (IO) failed before a second broke. A rubber-stoppered vial would have been a
humeral head EZ-IO was secured. better choice.
• Freeze-dried plasma (FDP) could not be reconstituted • It took approximately 10 minutes to transfer the FDP
quickly, and IO administration failed. and reconstitute. FDP infusion was slow because you
• Tranexamic acid (TXA) was lost when the only glass cannot use infusion pressure techniques on the FDP
vial available broke during opening. glass bottle. The FDP stopped flowing into the IO site
• Getting a litter to the patient took 25 minutes. after half the dose was administered.
• Blood products were requested with evacuation, but • The second casualty was not tracked to be on the
evacuation was delayed for a litter request that was hel icopter right away. (The PJ who responded on the
not made. ground had shrapnel in his face, but was not initially
• During an attempt to administer red blood cells (RBCs) recognized as a patient.)
during evacuation, the IO needle was pulled out. • Better communication with evacuation personnel
on 9 Line would have helped. Blood products were
The casualty survived his injuries. requested, but they would not launch the birds un-
til they knew how many litters we needed. No litters
Casualty #2 was a pararescueman (PJ) who was injured were ever requested. That miscommunication cost 12
responding to casualty #1. He suffered shrapnel injuries minutes to an already 30-minute response time.”
to his face.
3. TCCC Training in the 75th Ranger Regiment: MAJ
Lessons learned (“Sustains”) from this Operation were Andy Fisher, 75th Ranger Regiment, briefed the Com-
as follows: mittee on developments in Ranger Tactical Combat Ca-
• Wounds were rapidly identified and treated. sualty Care (TCCC) training. Ranger First Responder
• Great team work and communication at point of in- (RFR) training is based on TCCC and taught to both
jury and at treatment site. medics and nonmedical personnel during Ranger Assess-
• SOFT-T III tourniquet was rapidly and effectively ment and Selection Training. Currently, sustainment at
placed. platoon and company levels may not be robust or accu-
• 10mg of hydromorphone were given intramuscularly rate. All Ranger Medics should become TCCC instruc-
without relief of pain. tors. Moving forward, the RFR Program of Instruction

138