Page 143 - JSOM Fall 2019

The current training program occurs in three phases. Phase to upgrade the HPMK after short-term use (<60 minutes) to a
1 is classroom familiarization. Phase 2 is initial hands on heated and insulated hypothermia wrap.
raining via the Basic Endovascular Skills for Trauma (BEST)
Course with its military module and static live tissue training Further, the TCCC hypothermia prevention guidelines do not
incorporated into surgical team training. Also included in the provide specific guidance for battery-powered intravenous
training module was the ARC plan for use of whole blood in (IV) blood warming devices. New research and SOF medic
resuscitating casualties with NCTH and shock; there were also preferences indicate there are devices that provide improved
practical pointers regarding far-forward Zone 1 REBOA tech- blood delivery temperature in cold environments.
nique from JTS surgical personnel. Phase 3 of ARC training is The current wording for this proposed change is as follows:
dynamic training in exercises.
Care Under Fire
7. Hypothermia Prevention
18. Abdominal Evisceration Injuries in TCCC:
LTC Jamie Riesberg – 10th Special Forces Group a. Anticipate hypothermia in all trauma patients.
Tactical Field Care & Tactical Evacuation Care
In World War I, casualties with eviscerating injuries were tri-
aged as expectant. Mortality ranged between 55% and 75%. 7. Hypothermia Prevention
During World War II, mortality dropped to 18% to 36%. a. Take early and aggressive steps to prevent further body
Management consisted of covering eviscerated organs and heat loss.
transporting. In Vietnam mortality dropped to as low as 10%. b. Minimize casualty’s exposure to cold ground and air
temperatures. Get the casualty onto an insulated surface
Most eviscerations are accompanied by one or more abdomi- as soon as possible. Keep protective gear on or with the
nal organ injuries, so evisceration is an absolute indication for casualty if feasible.
laparotomy. There is no need for a CT scan. c. Replace wet clothing with dry and minimize exposure to
cold with an improvised shelter when possible.
Most commonly, current civilian practice is to cover eviscer-
ated tissues with sterile dressings, wet down the dressings with d. Apply the Ready-Heat blanket from the Hypothermia
sterile saline, and transport the patient. Prevention and Management Kit (HPMK) to the casual-
ty’s torso (do not place Ready-Heat blanket directly on
Over the years various groups have published conflicting ad- the skin to prevent burns), and enclose the casualty with
vice regarding replacing eviscerated intestines back into the the Heat Reflective Shell (HRS).
abdominal cavity. Typically, though, the hole in the abdominal e. If an HRS is not available, the previously recommended
wall is either too small to allow replacement or so big that the combination of the Blizzard Survival Blanket and the
replaced intestines pop right back out. Ready-Heat blanket may also be used.
f. If the items mentioned above are not available in cold
In the present conflicts, eviscerating injuries (in the absence
of NCTH) have not been implicated as a significant cause of environments, create a hypothermia enclosure wrap us-
preventable death and the TCCC Guidelines are silent on this ing a large waterproof tarp, such as, a waterproof bivvy
topic. There have been several recent requests, however, from sack, or multiple poncho liners as the outer layer, then
the TCCC User Community for TCCC to provide recom- insulate the patient with hooded sleeping bags, wool
mendations on the management of these injuries. LTC Ries- blankets, polar fleece clothing or anything that will re-
berg will continue to review the literature and work with his tain body heat and keep the casualty dry.
Change Team to develop a proposed addition to the TCCC g. Upgrade the HMPK if patient complains about being
Guidelines on this topic. cold, or if unconscious and skin feel cold, to an insu-
lated hypothermia enclosure wrap warming system, and
during transition to prolonged field care.
19. Prevention and Management of Hypothermia:
Dr Brad Bennett – Former Vice-Chair of Military and h. Warm (38–42°C) IV blood products are preferred if
Emergency Medicine – Uniformed Services University transfusion is required. The BuddyLite, ThermoSens,
Warrior, or EnFlow commercial battery-powered IV
There has been no change in the TCCC hypothermia preven- warming devices with insulated IV tubing wraps are
tion recommendations for over 13 years (Nov 2005). better device options when in cold environments.
i. Protect the casualty from prolonged wind exposure on
New research (Dutta et al., 2019 – in press) reports that the
HPMK was ranked last in objective and subjective measures any evacuation platform.
as compared to four other rewarming kits when evaluated in CAPT (Ret) Bennett and his team are continuing to refine the
a cold chamber study (–7°F for 60 minutes) using humans. proposed change wording and to smooth up the change paper
(Chairman’s note: The Dutta study also notes that the price for that supports it.
the HPMK is approximately $100, while some of the preferred
units are over $900 and that none of the thermal ensembles Breakout Session Briefbacks
tested produced a drop in core temperature in the five test 20. Maritime TCCC Breakout Session Briefback:
subjects during the study period.)
CAPT Chris Kurtz – Deputy Chief for Fleet Operations –
Additionally, feedback from the field indicates that the HPMK Navy Bureau of Medicine and Surgery
has limitations keeping casualties warm during prolonged
cold weather use, and some SOF units are augmenting with It is hard to apply TCCC phase labels to emergency medical
the ChillBuster 8000 (AC/DC rewarming blanket) for hypo- care on a ship. NATO MedNP will look at TCCC ASM in
thermia management. light of its emphasis on the concerns of the naval contingent.
MedNP is seeking collaboration with the CoTCCC on its mar-
Feedback from the field indicates that various US Special Op- itime module.
erations units planning for prolonged field care are teaching
CoTCCC Meeting Minutes | 141