Page 20 - Journal of Special Operations Medicine - Summer 2016

Case Series arrival. The patient arrived 32 minutes after sustaining
bilateral, lower extremity traumatic amputations from a
Prehospital Activation: Case 1 DCBI. Field-applied C-A-Ts were in place bilaterally on
A 21-year-old male US Marine presented to the role 2 his upper thighs. His ISS was 18 and initial vital signs
MTF via the US Army medevac system after sustaining were as follows: BP, 63/palpated; HR, 113; RR, 22; and
an injury during Operation Enduring Freedom (OEF) Spo , 99%. He received a massive transfusion with FWB
2
combat operations. Communication to the role 2 MTF as part of rDCR. The first unit of FWB was transfused
was initiated by his unit corpsman and the WBB was approximately 21 minutes after arrival (Table 2). Before
activated, anticipating his arrival. He arrived 28 min- resuscitation, initial POC laboratory studies were signif-
utes after sustaining bilateral, lower extremity trau- icant for pH/BE of 7.556/−3; his initial hemoglobin level
matic amputations and left upper extremity soft tissue was 15 g/dL and hematocrit was 44%. TXA was given
injury from a dismounted complex blast injury (DCBI). during resuscitation. The patient was intubated and a
Field-applied Combat Application Tourniquets (C-A-Ts; CVC was placed before salvage and wound debride-
Composite Resources Inc.; http://combattourniquet.com) ment surgery. His total OR time was 40 minutes and a
were in place bilaterally on the upper thighs and his response to treatment was noted (Table 1). His time of
left upper arm. His Injury Severity Score (ISS) was 17. transfer from the role 2 MTF to the next echelon of care
Initial vital signs were as follows: blood pressure (BP), was 88 minutes. On 30-day follow-up, the patient was
96/56; heart rate (HR), 122; respiratory rate (RR), 16; noted to have survived his injuries. No transfusion reac-
and blood oxygen saturation by pulse oximetry (Spo ), tions or infectious complications were noted at 30 days.
2
100%. He received a massive transfusion with FWB as
part of rDCR. The first unit of FWB was transfused ap- Prehospital Activation: Case 3
proximately 13 minutes after arrival. Before resuscita- A 23-year-old male US Marine presented to the role 2
tion, initial point-of-care (POC) laboratory studies were MTF via the US Army medevac system after sustain-
significant for an initial pH of 7.055 and base excess ing an injury during OEF combat operations. Com-
(BE) of −11. His initial hemoglobin level was 10.5g/dL munication to the role 2 MTF was initiated by his unit
and hematocrit was 31%. The patient was given tran- corpsman and the WBB was activated, anticipating his
examic acid (TXA) during limited component therapy arrival. He arrived 26 minutes after sustaining bilateral,
resuscitation (Table 1). The patient was intubated and lower extremity traumatic amputation from a DCBI.
a central venous catheter (CVC) was placed before sal- Field-applied C-A-Ts were in place bilaterally on his up-
vage and wound debridement surgery. His total operat- per thighs. His ISS was 33 and initial vital signs were as
ing room (OR) time was 60 minutes and a response to follows: BP, 142/57; HR, 150; RR, 18; and Spo , 100%.
2
treatment was noted (Table 1). His time of transfer from He received a massive transfusion with FWB as part of
the role 2 MTF to the next echelon of care was 150 rDCR. The first unit of FWB was transfused approxi-
minutes. On 30-day follow-up, the patient was noted to mately 10 minutes after arrival (Table 2). Before resus-
have survived his injuries. No transfusion reactions or citation, initial POC laboratory studies were significant
infectious complications were noted at 30 days. for pH/BE of 7.161/−11; his initial hemoglobin level
was 15.3 g/dL and hematocrit was 45%. The patient re-
Prehospital Activation: Case 2 quired a massive transfusion and TXA was given during
A 22-year-old male US Marine presented to the role 2 resuscitation. The patient was intubated and a CVC was
MTF via the US Army medevac system after sustain- placed before salvage and wound debridement surgery.
ing an injury during OEF combat operations. Com- His total OR time was 54 minutes and response to treat-
munication to the role 2 MTF was initiated by his unit ment was noted (Table 1). His time of transfer from the
corpsman and the WBB was activated, anticipating his role 2 MTF to the next echelon of care was 274 minutes.

Table 1 Vital Signs
Case 1 Case 2 Case 3 Case 4
Initial Transfer Initial Transfer Initial Transfer Initial Transfer
SBP 96 133 63 97 142 132 128 113
DBP 56 71 P 55 57 76 100 50
HR 122 99 113 92 150 113 145 105
RR 16 10 22 12 18 12 18 12

Spo 100 100 99 100 99 100 100 100
2
SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; RR, respiratory rate; Spo , blood oxygen level.
2

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