Page 82 - JSOM Fall 2018

demonstrations (9%), real­time feedback from debates with force depends upon angle of force and fixation technique: a
experts (9%), training ideas and recommendations (13%), study of 7 methods. BMC Anesthesiology 2014. 14:74.
interactive discussions and comments (12%), and exposure
to clinicians outside their environment (11%). Sustainable This SORT of Night: Two Mass Casualty Events
Medical Training. Over 60% agreed the pages’ content helped in Operation Inherent Resolve
training their colleagues, unit, or company (25% were neu­ SGT David Traficante, Team Medic and CPT(P) Jason Nam,
tral; 10% disagreed). Traditionally, participants responded Team Physician, SORT­B, 528th Sustainment Brigade (SO)(A),
they had sustained their medical training with texts and Fort Bragg, NC; CPT Robert D. McLeroy, Internal Medicine
studying (17%), practicing skills on their own (15%), by Resident, Madigan Army Medical Center, JBLM, WA; CPT
seeking out certification and training opportunities (17%), Rebecca Kent, Team Leader, SFC Kyle McAllister, Team Ser­
with social media discussions (12%). Almost 60% of partic­ geant and SSG Hubert Draper, Senior Medic, SORT­B, 528th
ipants preferred Facebook for a professional platform to dis­ Sustainment Brigade (SO)(A), Fort Bragg, NC
cuss medical issues.
Background: Special Operations Forces continue to conduct
Conclusions: Combat medics and their advocates should take missions in both austere and Grey Zone environments beyond
responsibility and provide quality FOAMed. This is benefi­ doctrinal evacuation timelines. The Special Operations Re­
cial to not only the medics, but also their patients, as they are suscitation Team (SORT) is the only Role II provider in US
the recipient of the prehospital professional’s knowledge base. Army Special Operations Command. The SORT is an 8­person
Prehospital medicine is often overlooked as a meaningful and team comprised of a Team Leader, Team Sergeant, Physician,
impactful component of the healthcare system. Providing these three SOCMs, X­ray technician, and Laboratory technician
outlets of FOAMed has, and will continue to add to the valid­ tasked to perform damage control resuscitation, prolonged
ity and efficacy of the prehospital profession. field care, and casualty evacuation.
Methods: In support of Operation Inherent Resolve, the SORT
was located with a forward ODA and partner forces and suc­
TOP POSTER PRESENTATIONS cessfully managed two mass casualty (MASCAL) events of
note. The data was collected from trauma casualty tracker
Can Unplanned Extubation Be Prevented? for each event. A comprehensive after­action review was con­
Introducing a Novel Airway Stabilization System ducted to review interventions, and casualty cards were all
for the Critically Ill SOF Patient photographed prior to patient transfer.
Shean Phelps, MD, MPH, Emerson, GA; COL Sean Hollon­
beck, MC, MPH, SFS, Fort Rucker, AL; Arthur Kanowitz, Results: In the first event, the SORT had a physician, three
MD, FACEP, Founder, CEO & CMO, Securisyn Medical, SOCMs, and two ancillary technicians. It had the capacity to
LLC, State of Colorado EMS and Trauma Medical Director run two critical care beds and functioned out of a building of
(2008–2017), Highlands Ranch, CO opportunity. The SORT treated 13 partner force casualties from
a VBIED attack in a 12 hour period with no fatalities at time of
Background: Airway control in the critically injured patient is evacuation. The second event required the SORT to operate with
a significant challenge for the Special Operations medic. Al­ a lighter footprint due to tactical requirements: one critical care
though the incidence of unplanned extubation in the combat bed out of a vehicle. The SORT had a nurse, two SOCMs, and
setting is not cited in the current literature, it likely occurs one ancillary technician. They treated 9 partner force casualties
commonly due to inadequate mechanical options (i.e., tube from a VBIED attack also with no fatalities at time of evacuation.
holder, tape) for securing the airway. When combining the
rigors of operating in degraded, denied, or austere environ­ Discussion: These events highlight that the SORT continues to
ments, with the inherent challenges of SOF casualty transport validate its place on the battlefield. The SORT was able to be
to higher levels of medical care, a single unplanned extubation strategically placed far forward and respond effectively to two
is one too many. MASCAL events while enabling the ODA and partner forces
to continue to conductive offensive operations. Both events
Recent studies show that in the more controlled environment also show that the SORT’s footprint is scalable to match its
of the ICU, unplanned extubation occurs in at least 7% of in­ tactical and operational environments.
tubated patients and results in significant morbidity and mor­
tality. Unplanned extubation occurs when a force to remove
1,2
the tube exceeds the force to restrain the tube. The greater PODIUM PRESENTATIONS
force a tube holder can restrain against the more likely it will
prevent accidental tube removal. Studies show that the most The Operational Advantages of Utilizing Enteral
commonly used tube holders fail at forces (14–19 lbs.) much Resuscitation for Severe Burn Injury in Prolonged
too low to prevent unplanned extubation. 3 Field Care Scenarios
Dr David Burmeister, Research Physiologist, Dr Belinda Go­
However, a novel Airway Stabilization System (FDA clearance mez, Postdoctoral Associate, Dr Tony Chao, Postdoctoral As­
expected in mid­2018) has demonstrated the ability to restrain sociate, Dr Jennifer Gurney, COL, Surgeon and Dr Michael
against almost 100 lbs. tube removal force. This device should Dubick, Task Area Manager, United States Army Institute of
be studied by Special Operations Medics against current stan­ Surgical Research, JBSA Fort Sam Houston, TX
dards of care to evaluate its efficacy, ease of use, and applica­
bility to the Special Operations environment. Police Department Tactical Medicine (TACMED)
1 da Silva PS, et al. Unplanned Endotracheal Extubations in the Program Impact on Trauma Patient Mortality:
Intensive Care Unit: Systematic Review, Critical Appraisal, and A Review of a Large Rrban EMS and TACMED System
Evidence­Based Recommendations. Anesth Analg. 2012 May; Elliot Ross, MD, MPH, San Antonio Uniformed Services
114(5):1003­14. DeGroot RI, et al. Risk factors and outcomes Health Education Consortium and David Wampler, Univer­
2
after unplanned extubation in the ICU: A case control study. sity of Texas Health Science Center, San Antonio, TX; Av­
3
Critical Care, 2011, 15:R19. Wagner JL, et al. Extubation ery Kester, Xandria Gutierrez, Crystal Perez, Lauren Reeves,

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