Page 8 - JSOM Winter 2018

by Allison Esposito, Managing Editor

2018 INVICTUS GAMES drones repeatedly and accurately delivered medical supplies
The Invictus Games, an event created in 2014 by Prince Harry, faster than other methods without additional risk to personnel
is a parasport event for wounded, injured, or sick armed or manned airframe.
services personnel and their associated vet-
erans. For much more information on the FEATURE ARTICLES
games, please go to https://www.invictus Advanced Resuscitative Care in Tactical Combat Casualty
games2018.org/. Please also see Bragg Soldiers Representing Care: TCCC Guidelines Change 18-01 14 October 2018
Team USA at Invictus Games for the personal journey of com- Advanced Resuscitative Care, as described here, reflects the
petitor US Special Forces medic First Sgt Jarrid Collins. work of the Committee on Tactical Combat Casualty Care. It
is a bold change in the advancement of battlefield medicine.
CASE REPORTS The interventions recommended in this paper address the larg-
Larger-Caliber Alternative Devices for Decompression est remaining cause of potentially preventable death on the
of Tension Hemopneumothorax in the Setting of battlefield, and represent an initiative to bring the capability
Hemorrhagic Shock for massive resuscitation with whole blood and control of ab-
The 14-gauge angiocatheter has an unacceptably high failure dominopelvic torso hemorrhage closer to the point of injury.
rate in treatment of tension pneumothorax (tPTX). The au-
thors found that increased hemothorax (HTX) volume did Use Your Noodle to Simulate Tourniquet Use
not predispose tension physiology; however, smaller-caliber on a Limb With and Without Bone
devices were associated with more failures and longer times to The purpose of this study was to simulate first aid by me-
rescue in 20% HTX as compared with 10% HTX. chanical use of a limb tourniquet on a thigh with and without
bone to better understand best caregiving practices. Two in-
Pneumonitis and Respiratory Failure Secondary to Civilian vestigators studied simulated first aid on a new pool “noodle,”
Exposure to a Smoke Bomb in a Partially Enclosed Space a plastic cylinder with a central air tunnel into which they in-
The authors report on a 25-year-old man who was exposed to serted a wood dowel to simulate bone. The authors conclude
a Superior 3C smoke bomb. He developed respiratory distress that in simulated first aid, mechanical modeling demonstrated
and ultimately pulmonary fibrosis with marked loss in pul- how tourniquet compression applied to a limb squeezed the
monary function. This case emphasizes the potential hazards soft tissues better when underlying bone was present. Bone
of using smoke bombs even in semienclosed spaces and the loss altered the compression profile and may complicate con-
potential delay in the development of significant pulmonary trol of bleeding in care.
complications.
LETTER TO THE EDITOR
Victory I Consensus Document: Proposal for the Vertically
Implementation of the Hartford Doctrine in the paired images
Spanish Context of the band-
only, the
The intentional mass casualty incident (IMCI) experience and bone, and
associated published research from the United States are, un- the boneless
fortunately, not directly applicable to the Spanish model of groups.
emergency medical services. However, there is a series of com-
mon elements that served as a reference for the development
of an effective, evidence-based, IMCI consensus response plan
called Victoria I. Differences in Stress Shoot Performance Among
Special Forces Operators Who Participate in a Human
SPECIAL ARTICLES Performance Program Versus Those Who Do Not
Guerrilla Hospital Design and Lessons Learned The authors sought to determine if Army Special Operation
The author discusses the lessons that can be learned from older Forces (ARSOF) Operators who participate in the Tactical
sources when engaging in guerilla warfare medicine and sur- Human Optimization, Rapid Rehabilitation and Recondition-
gery, including “Guerilla Medical Service Structure, Size, and ing program perform significantly better on a simulated stress
Functions,” “Lessons Learned in World War II,” and “Under- shoot scenario than ARSOF Operators who do not participate
ground Hospital Rules of the Yugoslav Partisans.” in the program.
Use of Drone Technology for Delivery of Medical Supplies Feasibility Study Vascular Access and REBOA Placement:
During Prolonged Field Care From Zero To Hero
Care of trauma casual- Vascular access is a necessary prerequisite for REBOA place-
ment in patients with severe hemorrhagic shock. This study
ties in an austere envi- during an EVTM workshop showed that a comprehensive
ronment presents many theoretical and practical training program using a task train-
challenges, particularly ing model can be used for percutaneous femoral access and
when evacuation is not REBOA placement training of military medical personnel
immediately available. without prior ultrasound or endovascular experience.
The authors found that

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