Page 155 - Journal of Special Operations Medicine - Summer 2016

language for the guideline change. The Chairman will antishock trousers, the pelvic hemostasis belt, the AAJT)
call this proposal to a vote in the near future. and intra-abdominal techniques (e.g., gases such as
carbon dioxide and nitrogen, and hemostatic foams).
10. Operational Medicine in the Submarine Force: REBOA was the only endovascular approach discussed.
CAPT Matt Hickey, Force Medical Officer for the Sub- Dr Kheirabadi presented an overview of these devices’
marine Force Atlantic, discussed injury and illness on mechanisms of action, efficacy, problems caused by
submarines. TCCC has not had a major emphasis in their use, and current approval status under the Food
the submarine force because combat trauma typically and Drug Administration (FDA).
does not occur on board. Worldwide, there are approxi-
mately nine to 10 medical evacuations (MEDEVACs) In summary:
from deployed submarines each month. The approxi- • Significant progress has been made in developing new
mate proportions have generally been 25% psychiatric, technologies for trauma resuscitation and control of
25% injury (mostly blunt trauma), and 50% “all other” noncompressible (abdominal and pelvic) hemorrhage
causes. Independent Duty Corpsmen follow protocols in the emergency department or operating room.
to manage the most common submarine medical condi- • Translation of these technologies to the prehospital
tions. Very rare mass casualty events have been due to setting requires extensive operator training and may
collisions, fires, or environmental malfunctions. CAPT not be possible to implement safely.
Hickey noted that TCCC might have applicability in • In a 2-hour application, the lower body ischemia
improving survival in the event of blunt trauma events produced by the AAJT caused significant metabolic
or casualties that occur in submarine-based Sea, Air, derangements similar to crush syndrome that were
and Land (SEAL) operations. Four ballistic missile sub- life-threatening at the time of pressure release and tis-
marines have been converted to support Naval Special sue reperfusion (hyperkalemia and acidosis). Hyper-
Warfare missions. These missions can be supported as kalemia treatment and cardiopulmonary support are
needed by embarked, smaller, mobile surgical units such necessary at the time of release of AAJT to overcome
as the Navy’s Expeditionary Resuscitative Surgical Sys- possible respiratory or cardiac arrest. The long-term
tem, which have the capability to provide damage con- effects of AAJT use and its potential damage on the
trol surgery at a Role 2 level of care. abdominal organs (e.g., intestines, bladder, and kid-
neys) are unknown and are the subject of the current
11. Air Force Pararescue Capabilities Briefing: MSgt independent safety review.
Travis Shaw presented an overview of the organization • Experimental studies in swine showed that carbon
and capabilities of the US Air Force (USAF) PJ commu- dioxide insufflation reduced blood loss in nonlethal
nity. PJs are not just Combat medics; they are Combat parenchymal bleeding (liver or splenic injuries) in
search and rescue specialists whose mission also in- 30-minute experiments. The optimum insufflation
cludes providing medical care and performing recovery pressure was 20mmHg, which was produced with a
operations. Their medical training includes TCCC and portable insufflator.
paramedic certification, and contains many other ele- • A more feasible approach is likely to be prehospital
ments of prehospital care as well. MSgt Shaw described administration of blood or blood products along with
the structure and missions of the USAF Rescue (Guard- hemostatic drugs or new synthetic polymers to re-
ian Angel) units aligned under Air Combat Command store plasma volume and stabilize blood clots so they
and the Special Tactics Squadrons aligned under the Air remain intact during fluid resuscitation and help to
Force Special Operations Command. He also presented minimize rebleeding.
examples of a variety of PJ capabilities, including tac-
tical proficiency, collapsed structure rescue, confined Following the presentation, Dr Butler presented Dr
space rescues, technical rescues, swiftwater rescue, open Kheirabadi with a CoTCCC Special Award for his out-
ocean rescue, and mountain/avalanche rescue. MSgt standing contributions to improving battlefield trauma
Shaw presented a selection of recent missions that illus- care through his many research accomplishments in he-
trate the wide range of tactical emergencies to which PJs mostatic dressings, chest seals, noncompressible hemor-
can effectively respond. rhage, and junctional tourniquets.

13. iGel as the Proposed CoTCCC Supraglottic Airway
WEDNESDAY, 3 FEBRUARY 2016
of Choice: Dr Mel Otten presented the iGel supraglot-
12. Medical Devices for Control of Noncompressible tic airway (SGA) to the group. In 2012, the CoTCCC
(Truncal) Hemorrhage: Dr Bijan Kheirabadi from the US removed recommendations for specific SGA devices
Army Institute of Surgical Research discussed exovascular from the TCCC guidelines because there are now a num-
and endovascular hemostatic devices. Exovascular de- ber of commercially available SGAs and there was no
vices include external compression devices (e.g., military clinical evidence that any specific SGAs were superior to

CoTCCC Meeting Minutes 141