Page 149 - Journal of Special Operations Medicine - Spring 2017

Table 6 PFC Provider Qualifications and Teleconsultation Table 7 PFC Treatments
No. (%) No. (%)
Pararescuemen (PJ) 20 (37.0) Hemorrhage control
Special Operations Independent Duty 11 (20.4) Tourniquet 8 (14.8)
Corpsmen (SOIDC)
Hemostatic agent 4 (7.4)
Special Forces Medical Sergeant (18D) 7 (13.0)
Pressure dressing 8 (14.8)
Independent Duty Medical Technician 2 (3.7)
(IDMT) Airway
Paramedic (EMT-P) 22 (40.7) NPA 4 (7.4)
Physician 15 (27.8) Intubation 2 (3.7)
Teleconsultation 8 (14.8) Cricothyroidotomy 2 (3.7)
Breathing
Surgeon 5 of 8 (62.5)
Flight surgeon 2 of 8 (25.0) Supplemental O 2 9 (16.7)
Emergency medicine physician 1 of 8 (12.5) Bag-valve-mask ventilation 3 (5.6)
Mechanical ventilation 4 (7.4)

cricothyroidotomy in two other patients. These same Circulation
four airway patients required subsequent mechanical Peripheral intravenous access 33 (61.1)
ventilation, while three other patients received bag valve Intraosseous access 1 (1.9)
mask ventilation. Supplemental oxygen was used in Crystalloid administered 25 (46.3)
16.7% (9/54) of cases. Intravenous access was obtained
61.1% (33/54) of the time and fluids were administered Blood products administered 7 (13.0)
to 48.1% (26/54) of patients, of which 96.1% (25/26) Packed red blood cells (8 units) 4 (7.4)
received crystalloids and 26.9% (7/26) received blood Whole blood (21 units) 2 (3.7)
products. The most common blood product was whole Plasma (2 units) 2 (3.7)
blood (21 units); however, the majority of this blood (19
units) was used in the care of one patient. Packed red Medications
blood cells were transfused in four patients, and two pa- Medication administered 31 (57.4)
tients received plasma. Medications were administered Pain medication 24 (44.4)
in 57.4% (31/54) of patients with analgesics being the Antibiotic 12 (22.2)
most common (44.4%; 24/54) followed by antibiotics
(22.2%; 12/54). Tranexamic acid was used in 7.4% Tranexamic acid 4 (7.4)
(4/54) of patients (Table 7). There was no reported ad-
ministration of vasopressors. AARs. The prehospital time of care ranged from 4
hours to 120 hours, with a median time of 10 hours,
Wound care, splinting, and general nursing care were before reaching a higher level of care. While ultimate
also identified as important PFC skills assessed in the outcomes were not always available to our respon-
survey; however, in this retrospective patient series they dents, 9.3% (5/54) died prior to transport to the next
were infrequently reported. level of care (Table 4).

Delivery, Duration, and Mortality Open-Ended Responses
The primary mode of transport to the next level of care Open-ended questions were included as part of the sur-
was via air 55.6% (30/54), of which 50.0% (15/30) vey in order to capture points of sustainment and im-
were by rotary wing aircraft and 50.0% (15/30) were provement. Responses were received on 72.2% (39/54)
by fixed wing aircraft. The remainder were transported of cases, which were divided into equipment issues
by sea (14.8%; 8/54) and ground (5.6%; 3/54) con- (17.9%, 7/39), recommendations for pre-mission train-
veyances, or unspecified 24.1% (13/54). For transport ing (46.2%, 18/39), successful efforts to sustain (35.9%,
destination, 25.9% (14/54) were delivered to a Role 14/39), and opportunities to improve (79.5%, 31/39).
2 forward surgical team, 14.8% (8/54) were delivered For equipment issues, the primary failure noted was bat-
to a Role 4 hospital, 20.4% (11/54) were delivered to tery depletion, which occurred in three cases including
a host nation hospital, and the remainder were other one that discharged quickly due to cold weather. For
continental US hospital (1.9%; 1/54) or unspecified pre-mission training, first responder TCCC training was
(37.0%; 20/54). The duration of prolonged care was recommended in five cases. Other topics recommended
clearly recorded on 92.6% (50/54) of patient care for training included tropical medicine, shipboard

Review of 54 Cases of Prolonged Field Care 125