Page 114 - Journal of Special Operations Medicine - Fall 2016

Table 1 Summary of Evidenced-Based Medicine Adapted to the Tactical Environment
Maneuver Purpose Outcome
Blood sweep Rapid identification of significant Successful identification of multiple bleeding
extracavitary hemorrhage wounds
Hemostatic dressing To provide improved hemostasis over Cessation of bleeding from all wounds
standard gauze dressing treated with hemostatic dressings
Freeze-dried plasma Far-forward prevention and treatment Improved intrinsic coagulation, improved
of trauma-related coagulopathy, volume hemodynamics
expansion
Tranexamic acid Antifibrinolysis for early treatment Early treatment of hyperfibrinolytic state,
and prevention of trauma-related improved intrinsic coagulation, improved
hyperfibrinolysis hemodynamics
Needle decompression Relief of tension pneumothorax Repeated successful treatment of recurrent
tension pneumothoraces
Hypothermia prevention and Prevention and treatment of hypothermia Mitigation of hypothermia in tactical, below-
management kit freezing conditions
Portable ultrasonography Diagnostic test for internal hemorrhage Intracavitary bleeding identified within
bilateral pleural spaces, exclusion of intra-
abdominal hemorrhage
High-ratio transfusion with Prevention and treatment of trauma-related Restoration of hemodynamics after
warmed blood products coagulopathy, volume expansion without hemorrhage control
hemodilution (damage control resuscitation)
Tactical surgery Far-forward, expeditionary, abbreviated Definitive hemorrhage control of internal
surgical hemostasis (damage control surgery) bleeding within moments of injury
Training To train as we fight, enhance complex tactical Medical-force projection into the tactical
decision-making, adoption of evidence-based environment
medicine to the tactical environment
Avoidance of crystalloid To prevent acidosis and hemodilution, No crystalloids were administered, avoiding
prevention of coagulopathy hemodilution and coagulopathy

Disclosures LTCDR Spradling was a member of the tactical assault force
involved in the events described in this article.
The authors have nothing to disclose.
LTCDR Littlejohn was a member of the tactical assault force
involved in the events described in this article.

SGT McKenzie was a member of the tactical assault force SSG Quinlan was a member of the tactical assault force in-
involved in the events described in this article. volved in the events described in this article.

SGT Parrish was a member of the tactical assault force in- MAJ Barbee was a member of the tactical assault force in-
volved in the events described in this article. volved in the events described in this article.

LTC Miles was a member of the tactical assault force involved LTC King was a member of the tactical assault force involved
in the events described in this article. in the events described in this article. He is an attending trauma
and acute care surgeon. E-mail: dking3@mgh.harvard.edu.

96 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016