Page 97 - Journal of Special Operations Medicine - Fall 2016

ACCOUNTABILITY | DECISION-MAKING
LEADERSHIP | PROFESSIONALISM

An Ongoing Series

Management of Crush Syndrome Under Prolonged Field Care

Thomas Walters, PhD; Douglas Powell, MD; Andrew Penny, NREMT-P;
NTOA ACADEMY Ian Stewart, MD; Kevin Chung, MD; Sean Keenan, MD; Stacy Shackelford, MD

COMMAND COLLEGE Introduction to the Prolonged Field Care beyond the initial evaluation and treatment of casual-

A dynamic learning experience using online, residency and experience-based Prehospital Clinical Practice Guideline Series ties in a PFC operational environment. This and fu-
ture CPGs are aimed at serious clinical problems seen
tactical learning modules. Sean Keenan, MD less frequently (e.g., crush injury, burns) or where fur-
ther advanced practice recommendations are required
THIS FIRST CLINICAL PRACTICE GUIDELINE (CPG) (e.g., pain and sedation recommendations beyond
was produced through a collaboration of the SOMA TCCC recommendations, traumatic brain injury).
TACTICAL COMMAND CERTIFICATION Prolonged Field Care Working Group (PFCWG) and
he NTOA Academy the Joint Trauma System (JTS) at the U.S. Army Insti-

Ttakes the professional- The blended learning program incorporates leadership concepts, tute of Surgical Research (USAISR) in San Antonio. Of We hope that this collaboration of experienced op-
erational practitioners and true subject matter ex-
theories and models, and applies them to the role of the Tactical note, this effort is the result from requests for informa- perts, operating under the guidance set forth in past
ization of SWAT to the next Commander and Team Leader. This intensive three-tier certification tion and guidance through the PFC website (PFCare.org) JTS CPG editorial standards, will bring practical and
level by providing for the program prepares students to anticipate and manage current and and from the Joint Special Operations Medical Training applicable clinical recommendations to the advanced
Center instructors located at Fort Bragg, North Carolina.
practice first responders and Role 1 providers in the
certification of SWAT Team future challenges facing their team, agencies and communities. We are excited to introduce the first prehospital (pre- field. For feedback or additional input, please visit

Leaders and Commanders. surgical) CPG specifically aimed at providing guidance PFCare.org.

The curriculum consists of LEADERSHIP PRINCIPLES

online education, residency The comprehensive Learning Modules focus on contemporary lead- his Role 1, prolonged field care (PFC) guideline Crush syndrome is a reperfusion injury that leads to

courses and capstone re- ership principles and concepts such as Transformational, Servant is intended to be used after Tactical Combat Ca- traumatic rhabdomyolysis. Reperfusion results in the
search project requirements. and Tactical Leadership; Motivation, Strategic Planning and Change Tsualty Care (TCCC) Guidelines when evacuation release of muscle cell components, including myoglobin
to higher level of care is not immediately possible. A
and potassium, that can be lethal. Myoglobin release
Management; Communication and Ethical Decision-Making. provider of PFC must first and foremost be an expert in results in rhabdomyolysis, with risk of kidney damage.

TCCC. This Clinical Practice Guideline (CPG) is meant
to provide medical professionals who encounter crush Hyperkalemia can cause kidney damage and cardiac ar-
rhythmias. Calcium is taken up by injured muscle cells
National Tactical DECISION-MAKING syndrome in austere environments with evidence-based and this can cause hypocalcemia, contributing to cardiac

Officers Association guidance for how to manage the various aspects of crush arrhythmias. The risks are increased with large areas of
The intensive three-phase program directs and challenges students injury care and monitoring. Recommendations follow a tissue crushed (one or both lower extremities) and the
“minimum,” “better,” “best” format that provides al-
length of time the casualty is pinned prior to extrication.
P.O. Box 797 to plan and learn to make decisions at the Tactical, Operational and ternate or improvised methods when optimal hospital The primary treatment is aggressive fluid administration.
Strategic level. Students will engage in the analysis and planning of
Doylestown, PA 18901 dynamic tactical situations and apply current leadership principles options are unavailable. Reperfusion after prolonged tourniquet application (>2
800-279-9127 | ntoa.org while considering the effects on all stakeholders. Crush syndrome is a life and limb-threatening condi- hours), extremity compartment syndrome, and severe
tion that can occur as a result of entrapment of the ex- limb trauma involving blunt trauma can also result in
tremities accompanied by extensive damage of a large rhabdomyolysis by the same mechanisms as crush syn-
muscle mass. It can develop following as little as 1 hour drome, and the treatment is the same.
Go to: www.ntoaacademy.org of entrapment. Effective medical care is required to re- Telemedicine: Management of crush syndrome is
duce the risk of kidney damage, cardiac arrhythmia, and
death. complex. Establish telemedicine consult as soon as possible.
g Eligibility Requirements g Course Curricula Pricing FAQ’s Application
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Contact: Academy@ntoa.org 79