Page 156 - Journal of Special Operations Medicine - Summer 2016

others. To date, the King LT is the SGA most commonly 15. Saving Lives on the Battlefield - Return to Iraq: COL
trained in the military. However, it can be positioned too James Geracci, III Corps Command Surgeon, briefed the
proximally, so that air does not flow into the trachea, attendees on the nature of our current presence in Iraq.
and this has been noted to occur in combat casualties. Much of our former medical capability there is gone,
and Iraq is now a very austere theater. The recent return
The iGel is another SGA option for the combat medical of US military units to theater is very limited; economy
provider. Advantages of the iGel include the following: of force principles requires strict force manning limita-
• Smaller, lighter, and shorter than other SGAs tions and necessitate nondoctrinal solutions. As there is
• Does not have an inflatable portion no true medical hub and limited MEDEVAC capability
• Does not require a syringe in Iraq at present, damage control surgery must be pro-
• Cost is half approximately that of the King LT or laryn- vided very close to kinetic activity.
geal mask airway (LMA)
• Easier and faster to insert than other SGAs COL Geracci noted that some aspects of trauma care are
• Minimal reported complications working well at present:
• Easy to train • TCCC is the standard of care by both US Central
• Has a gastric port, an oxygen port, and easy access Command and Task Force mandate.
for fiber optic intubation • Operational leadership understands casualty care
management and the need to have both medical and
Multiple published studies have shown that the iGel nonmedical combatants able to perform lifesaving in-
performs well in comparison to other SGAs. One report terventions on the battlefield.
found that the iGel was placed correctly 96% of the • The “Vampire” blood program: blood components
time with minimal training. provided during tactical evacuation
• Critical Care Flight Paramedic training
An area of concern with the iGel is the lack of informa- • There is TCCC penetrance into coalition forces.
tion about how well it performs at low ambient tem-
peratures. Dr Otten has had a very favorable personal COL Geracci also noted a number of opportunities to
experience with this device and concluded with a recom- improve:
mendation that the iGel should be the named the pre- • Predeployment TCCC/trauma training is inconsistent
ferred SGA in the TCCC Guidelines. at best.
• Prehospital and Role 2 documentation is not being
14. Battlefield Medical Strategy: COL Shawn Nessen, reliably accomplished.
Trauma Consultant to the Army Surgeon General, re- • TCCC equipping is still incomplete, especially with
viewed the advancements in combat casualty care in respect to junctional tourniquets and analgesics.
the First World War, the Second World War, Korea, • Walking Blood Banks are not being used optimally.
and Vietnam. He described advances in trauma care • The theater trauma system is not robust. There is no
made during the conflicts in Iraq and Afghanistan, in- “trauma czar” and there is a lack of damage control
cluding the development of the Joint Trauma System, surgery/damage control resuscitation expertise far
American College of Surgeons certification of Landstuhl forward.
as a trauma center, improvements in the use of blood
products to include their location further forward on COL Geracci concluded by reinforcing the importance
the battlefield, use of Forward Surgical Teams, reduc- of “muscle memory” for TCCC and that TCCC should
tion in prehospital death from potentially survivable in- be mandated for every Soldier, medic, and leader. He fur-
juries through the application of TCCC principles, and ther stated that all operational physicians and physician
the development of new prosthetics and orthotics. COL assistants (PAs) in III Corps and all resident physicians
Nessen presented several representative case reports of at Fort Hood are now required to be NAEMT-TCCC
casualties with very severe injuries and described their trained.
management.
16. Squad Overmatch TCCC Training: COL Dan Iri-
In the future, military medical units must be able to zarry, clinical advisor for the Joint Program Management
maneuver and move with their supported units on the Office for Medical Modeling and Simulation, described
battlefield. Strategic concepts must focus on medical this blended training system designed to optimize both
support early in theater opening, recognizing that the squad performance in TCCC and small-unit casualty
Combat Support Hospital is the center of gravity for response. The Squad Overmatch TCCC (SOvM-TC3)
medical care. In addition, Army medicine must be re- training project uses squad overmatch techniques and
sponsive to an ever-changing host of nonbattle contin- blended instruction technologies (moulage, manikins,
gency operations in new theaters of combat. virtual reality) to create integrated training in TCCC. He

142 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016