Page 108 - Journal of Special Operations Medicine - Winter 2016

■ Alternative: instead of cream, use silver ny- Surgeon, 82d Airborne Division, Operation Just Cause and
lon dressing (Silverlon, Argentum Medical, Desert Storm; with SOCCENT and 86th Combat Support
http://www.silverlon.com/), covered by gauze Hospital during Operation Iraqi Freedom; and with a For-
dressing. ward Surgical Team during Operation Enduring Freedom.
• Silverlon can be left in place for 3–5 days as MAJ Powell, MC, USA, is an intensive care physician cur-
long as the wound is clean when the Silver- rently serving as the 4th Battalion 3rd Special Forces Group
lon is applied. (Airborne) Surgeon and a staff intensivist at Womack Army
• The outer gauze dressings (e.g., Kerlix [Co- Medical Center.
vidien]) should be moistened (not soaked) at MSgt Adams, USAF, is an IDMT-P, FP-C, ATP, and Com-
least daily. Use sterile (or at least clean, un- bat Aviation Advisor with the Air Force Special Operations
contaminated) water or normal saline. Air Warfare Center (AFSOAWC)/Irregular Warfare Director-
• The outer gauze dressings should be changed, ate, where he directs/coordinates Aviation Foreign Internal
leaving the Silverlon in place, sooner than 3 Defense/Global Health Engagement missions in Special Op-
days if they become saturated with exudate erations Command Africa (SOCAF). He has served multiple
or otherwise dirty. deployments to Iraq/Afghanistan and Africa supporting Base
• If the patient develops any evidence of infec- Support Operations, casualty evacuations (CASEVAC) and
the CAA TCCC/CASEVAC missions. He also works part-time
tion, the Silverlon must be removed and the as a civilian critical care flight paramedic.
wound inspected sooner than 3–5 days.
• The Silverlon can be removed and cleaned LT Bull, MC, USN, formerly the Battalion Surgeon for 3d
in sterile, or at least clean uncontaminated, Marine Raider Battalion, Marine Special Operations Com-
mand, is a family medicine resident at Naval Hospital Camp
water and reused for up to 5 days. Lejeune. He is also a Navy Undersea Medical Officer.
■ Better: Clean wounds and debride loose dead
skin by washing with any antibacterial soap in Maj Keller, MC, USAF, is an emergency medicine physi-
clean water, dress wounds with any available cian serving as the group surgeon for the 720th Special Tac-
dressings; optimize wound and patient hygiene tics Group (AFSOC). He previously served as a CSAR flight
surgeon with multiple deployments to Iraq and Afghanistan
to the extent possible given environment. supporting rescue forces. Maj Keller is also an experienced
■ Minimum: Cover with clean sheet or dry gauze. tactical EMS provider having provided support to multiple
Leave blisters intact. Avoid wet dressings. law enforcement agencies to include the Dayton Police De-
partment SWAT and Vice Squad, as well as the FBI.
Antibiotics LTC Gurney, MC USA, is a general, trauma, and burn sur-
• IV or oral antibiotics are not normally used geon and currently works as the Chief of Trauma Systems De-
for prophylaxis in burn patients in the ab- velopment, Joint Trauma System, and the Deputy Director of
sence of other open wounds requiring them the Burn Center in San Antonio, Texas. She has multiple de-
(e.g., open fractures.) ployments to Iraq and Afghanistan as part of Combat Support
• After several days, if patient develops cel- Hospitals and Forward Surgical Teams.
lulitis (spreading erythema around edges of LTC Pamplin, MC, USA, is a board-certified intensivist and
burn), treat for gram-positive organisms, is currently the Director of Virtual Critical Care at Madigan
(e.g., cefazolin or clindamycin). Army Medical Center, Joint Base Lewis-McChord, Washing-
• If patient develops invasive burn wound in- ton. Previously, he was the Director of the US Army Burn Inten-
fection (signs: sepsis/septic shock, changes sive Care Unit and Chief of Clinical Trials in Burns and Trauma
in color of wound, possible foul smell of at the US Army Institute of Surgical Research, San Antonio,
wound), treat with broad-spectrum antibiot- Texas, and has served as the Simulation and Training Director
ics to include gram-positive and gram-nega- for the Extracorporeal Membrane Oxygenation Program, San
tive coverage that ideally includes coverage Antonio Military Medical Center, and the Director of the Sur-
for Pseudomonas aeruginosa (e.g., ertape- gical Intensive Care Unit, Brooke Army Medical Center.
nem + ciprofloxacin). Col Shackelford, MC, USAF, is a trauma surgeon, cur-
rently serving as the Chief of Performance Improvement, Joint
Fluid and equipment planning considerations. See Ap- Trauma System, San Antonio, Texas. She is a member of the
pendix E. Committee on TCCC and has previously deployed as the di-
rector of the Joint Theater Trauma System.
Summary Table. See Appendix F. COL Keenan, MC, USA, is a board-certified emergency
medicine physician, and is currently serving as Command Sur-
geon, Special Operations Command, Europe. He has previ-
ously served as Battalion Surgeon in both 1st and 3rd SFG(A),
COL (Ret) Cancio, MC, USA, is the senior burn surgeon at and as Group Surgeon, 10th SFG(A). He is the coordinator
the US Army Burn Center. He directs the Multi-Organ Support for the SOMA Prolonged Field Care Working Group. E-mail:
Task area. He deployed as 504 Parachute Infantry Regiment sean.keenan1.mil@mail.mil.

92 Journal of Special Operations Medicine Volume 16, Edition 4/Winter 2016