Page 71 - JSOM Winter 2017

Figure 1 Casualty flow diagram for 12-year SRT experience. thoracotomy was attempted in six casualties. Despite these ex-
haustive efforts, none of the 12 patients who presented without
signs of life survived their injuries.

The remaining 173 human casualties (Figure 1) were pre-
dominantly male (n = 166; 96.0%) and most had sustained
penetrating injuries (n = 157; 90.8%) from gunshot or frag-
mentation mechanisms. TCCC interventions provided be-
fore surgical team intercept included tourniquet placement
(36 of 173; 20.8%), peripheral intravenous access (24 of
173;13.9%), Intraosseous access (one of 173; 0.6%), airway
establishment (seven of 173; 4.0%), chest seal or thoracos-
tomy decompression (13 of 173; 7.5%), extremity splinting
(three of 173; 1.7%), and a variety of wound packings and
dressings. Blood products had been administered before inter-
cept by the SRT in 4.6% of the patients (eight of 173): whole
blood (n = 3), packed red blood cells (PRBCs; n = 3), thawed
plasma (n = 1), or freeze dried plasma (n = 1). Documented
medication administration before intercept included fentanyl
(21 of 173: 12.1%), versed (four of 173; 2.3%), ketamine (six
of 173; 3.5%), tranexamic acid (five of 173; 2.9%), and other
resuscitative adjuncts, including antibiotics and antiemetics
(13 of 173; 7.5%).

Time from injury to SRT intercept was recorded in 62 of the
augmentation of an existing MTF (n = 122; 70.5%) during 173 patients, with 33 (19.1%) evaluated and treated within
anticipated potential mass casualty events. In this context, 1 hour after injury. Seventeen of these patients (9.8%) were
the mean number of casualties treated per specific event was described as unstable, with variable documentation of spe-
4.4 (range, 1–10). Other roles for which the SRT was used cific vitals elements in reviewed AARs. From available specific
included the transfer of casualties in a tail-to-tail transfer data, mean heart rate was noted at 102/minute (46 casualties),
from a casualty evacuation airframe (three episodes; 1.7%) mean systolic blood pressure was 108mmHg (32 casualties),
to facilitate critical care transport from an established MTF mean oxygen saturation was 95% (29 casualties), mean GCS
to the next higher echelon of care (n = 20; 11.6%) as an inde- score was 14.6 (66 casualties), and mean temperature was
pendently deployed surgical capability in a ground structure/ 36.1°C (97°F; seven casualties).
hardstand (16 episodes; 9.2%) or in mobile response to a POI
casualty (n = 12; 6.9%). Initial interventions delivered by the SRT are listed in Table
1. These included the establishment of intravenous access
Case Series and Results (50.9%), airway placement (29.5%), and thoracostomy tube
From the reviewed AARs, data on 190 total casualties (n = (9.2%). Resuscitation was undertaken with whole blood
185 humans; n = 5 working military canines) treated were (3.5%; mean, 3.3 units), PRBCs (20.8%; mean, 5.2 units),
abstracted. and thawed plasma (11.0%; mean, 5.6 units). Medications
administered (Table 1) included fentanyl (18.5%), versed
Among the five canines, injuries included heat injury (n = 1), (11.0%), ketamine (11.0%), morphine (15.6%), tranexamic
suffocation (n = 1), and penetrating injuries due to gunshot acid (2.3%), antibiotics (26.6%), and other drugs (33.5%).
or explosive fragmentation (n = 3). One military working dog
was returned to duty after care. Two canines were evacuated The SRT provided DCS for 63 casualties (36.4%). Various
to a higher echelon of care. Two were without signs of life at surgical interventions were performed; most common were
intercept, were unable to be resuscitated, and died. complex wound debridement/washout (17 of 63 casualties;
27.0%), exploratory or damage control laparotomy (15 of
Among the 185 human casualties, 12 presented to the SRT 63; 23.8%), and arterial injury shunting or repair (12 of 63;
without signs of life (no pulse, Glasgow Coma Scale [GCS] 19.0%; Table 2).
score of 3, no respirations or detected cardiac activity). All had
sustained penetrating injuries due to gunshot or fragmentation. Of casualties delivered to the next echelon of care by the SRT,
Specific time of injury for these casualties was discernable in six 95.4% (n = 165) were characterized as stable, and three had
instances, with a mean time of delivery to the mobile surgical ongoing resuscitation in the face of persistent hemodynamic
capability of 61 minutes. Ten of the casualties presenting with- instability. Five patients died during SRT care. Three deaths
out discernable signs of life were encountered in the context of occurred during augmentation of an existing Role 2 military
MTF augmentation, with seven encounters occurring during treatment facility (MTF) and two occurred during transport
casualty events involving four or more patients. The other two from the POI to an established MTF. Overall survival among
were encountered during response directly to the POI (50 and patients intercepted by the SRT while any signs of life were
102 minutes from injury to intercept, respectively). The SRT present was 97.1%.
response to these casualties included cardiopulmonary resus-
citative efforts, including four endotracheal intubations, one Among the 62 patients for whom time from injury to inter-
cricothyrotomy, and four tube thoracostomies. Resuscitative cept was adequately documented, there was no statistically

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