Page 111 - Journal of Special Operations Medicine - Fall 2016

A Case of Prehospital Traumatic Arrest
in a US Special Operations Soldier

Care From Point of Injury to Full Recovery

Myles R. McKenzie; Ernest W. Parrish; Ethan A. Miles, MD; James C. Spradling, CRNA;
Lanny F. Littlejohn, MD; Mark D. Quinlan; George A. Barbee, PA-C; David R. King, MD

ABSTRACT
During an assault on an extremely remote target, a US Care Under Fire
Special Operations Soldier sustained multiple gunshot As the multilateral firefight continued to escalate, both SO
and fragmentation wounds to the thorax, resulting in a medics responded and suppressive fire was returned. The
traumatic arrest and subsequent survival. His care, in- casualty had no evidence of obvious massive external hem-
cluding care under fire, tactical field care, tactical evacu- orrhage after performing a blood sweep (i.e., a maneuver
ation care, and Role III, IV, and V care, is presented. whereby the medical provider rapidly runs his hands over
The case is used to illustrate the complex dynamics of the casualty’s entire body palpating for wetness of skin or
Special Operations care on the modern battlefield and uniform caused by bleeding). The firefight continued to
the exceptional outcomes possible when evidence-based evolve and the casualty was moved downhill and away
medicine is taken to the warfighter with effective, far- from the objective, where additional contact was received
forward, expeditionary medical-force projection. and suppressive fire was returned. The casualty was un-
stable on his feet but could ambulate, so he was assisted
Keywords: bleeding; arrest; thoracotomy; war; military by both medics to a location of cover and concealment,
where he was sat down and medical care continued.

Tactical Field Care
Introduction
The casualty’s tactical equipment was removed and an
During an assault on an extremely remote target, a US additional blood sweep was performed. The casualty
Special Operations Soldier sustained multiple gunshot was initially awake, alert, and able to answer questions.
and fragmentation wounds to the thorax, resulting in a During the secondary survey, multiple lacerations were
traumatic arrest and subsequent survival. The detail of identified on the left side of his face, caused by fragmen-
his care are presented. tation, as well as gunshot wounds to his anterior and
posterior right shoulder. His facial lacerations did not
present any life-threatening hemorrhage, but there was
Case Report significant bleeding from his right shoulder. The wound
was too high on the shoulder to control with a tourni-
Prologue quet, so it was exposed, packed with an advanced topi-
Under cover of darkness, in below-freezing conditions cal hemostatic dressing (Combat Gauze ; Z- Medica;
®
over very rough terrain, US Special Operations Forces http://www.z-medica.com) in both wound cavities, and
(SOF) assaulted an extremely remote mountainous tar- wrapped with a pressure dressing. Simultaneously, a unit
get. One Soldier came into close contact with the enemy of freeze-dried plasma (FDP) was reconstituted (Figure
on the target, just outside the primary objective. During 1). The FDP was handed off to a nonmedical Soldier to
the carefully executed firefight, this Soldier sustained swirl for 6 minutes, so that it would be ready to admin-
both fragmentation injuries from a hand grenade and ister by the time all wounds were identified and intrave-
multiple thoracic gunshot wounds from a rifle, and was nous (IV) access was obtained. [Note: FDP is available
temporarily incapacitated. Medical care was initiated to US Special Operations Command through a US Food
within moments of injury by two Special Operations and Drug Administration–approved Investigational
(SO) medics who were also in contact with the enemy. New Drug protocol.]

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