Page 43 - JSOM Spring 2018

FIGURE 2 Battlefield REBOA kit. (A) Case with complete FIGURE 3 Field environment for REBOA placement.
equipment set. (B–D) Individual REBOA kit components.
(A) (B)

(C) (D)

FIGURE 4 Ground ambulance environment for REBOA.

landmarks. The REBOA catheter is introduced through the
vascular sheath and secured in place.
For this study, all procedural time points were recorded and
difficulties encountered were noted. The time to balloon infla-
tion was calculated starting from the point when the ultra-
sound machine was turned on. The providers alternated being
the primary provider and assistant on each specimen, and the
femoral artery on each side of the specimen was used one time.
The REBOA procedure was conducted in a field environment
simulating point-of-injury care, and en route care was simu-
lated in a static and a moving ground ambulance, as well as
in-flight on a UH-60 Black Hawk.
Field environment
The field environment used for the study was outdoors in an
open wooded space at the top of a rocky hill. This area was
selected for its isolated location and protected view to prevent
the public from seeing. The patient was placed on a Talon II
Assault Litter Carrier (North American Rescue) and the pro-
cedure was performed with the patient on the litter. All proce-
dures were performed during midday with a bright overhead
sun. The sunlight provides a significant challenge to using ul-
trasound (Figure 3) To see the ultrasound screen, some form
of artificial shade had to be created. This challenge delayed
placement in most cases because of poor ability to visualize
the arteries.

Ground ambulance opaque black plastic; thus, use of headlamps was required to
A standard type II civilian ground ambulance was used for perform the procedure to simulate night conditions (Figure 5).
the ground transport. The patient was loaded onto the floor
of the ambulance on a Talon II Assault Litter Carrier. Proce- UH-60 Black Hawk
dures were performed while kneeling above the patient, with A US Army Sikorsky UH-60M Black Hawk (HH-60M
the assistant sitting at the head of the patient (Figure 4). Dur- MEDEVAC Black Hawk variant) was used for the flight en
ing the moving transport simulation (Table 2), the ambulance route care simulation. This was used in conjunction with
was driven over paved roads and gravel roads at 30–45 mph in scheduled daytime predeployment training for en route care
a rural area. This included multiple turns and stops through- providers within this aviation unit. The patient was cross-
out the transport. In addition, all windows were covered with loaded onto the aircraft with head and feet facing the doors.

Proposed Training Pathway for REBOA in Austere Environment | 39