Page 29 - JSOM Fall 2019

Equipment
Standard Course Schedule
Shared equipment updates are an important part of the course, Monday
looking at items such as oxygen concentrators and generators, 0830 – Welcome Brief NSHQ Staff
fluid warmers, in-flight noise-cancelling headphones linked 0900 – Course Overview
to 3G networks via voice-activated hands-free microphones, 0915 – Care under Fire
and magnetic chest mats to hold instruments secure yet close. 0945 – Why SF Soldiers Die
1000 – The SF Medical Emergency Response Team (SF-MERT)
One idea in particular has been the concept and development 1020 – Coffee
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of a damage control surgery (DCS) set. Most SOF surgical 1030 – Basic SOF (McRaven) Operational Principles
teams early in their development, and particularly when tran- 1130 – Austere DCR: Blood Transfusion
sitioning from the conventional environment, carry two basic 1200 – Austere DCS: Principles and Physiology
1230 – Lunch
sets, one chest set, one vascular set, two abdominal sets, and 1400 – SOF Surgery – Lessons from War
two orthopedic sets, for a total of eight sets. Sixty kilograms 1430 – The Role of the Team Leader
of equipment is then required for the treatment of just two 1500 – The Role of the Clinical Leader
casualties who can clearly be injured in multiple anatomical 1530 – Tea
locations. 1600 – Tour of SOMB Complex and Simulation Facility
1700 – End of Training Day for Team
Tuesday
The recognition of a generic skill and mind set for SOF DCS 0830 – Basics of SOF Operational Medical Planning
has changed this. There should be available a single appropri- 0930 – Clinical Governance on SF Operations
ate, agreed, and familiar surgical set that, when opened, could 0945 – Crew Resource Management (CRM) 1 – Situational
equally service a (damage control) laparotomy, a thoracotomy, Awareness
a vascular shunt or repair, a pelvic packing and stabilization, 1000 – Coffee
1015 – Scenario One Brief and Facilitated Whiteboard Planning
a wound debridement, and a limb fasciotomy. As an example, Exercise
the current UK DCS set measures 36 × 22 × 11 cm, weighs 1100 – Team Set-Up (Desert Safe House)
6kg, and is capable of performing all current damage control 1130 – Team Equipment and Internal Casualty Reception Drills
and resuscitation procedures (Figure 1). Each set is paired with 1230 – Lunch
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a Hoffman -3 magnetic resonance imaging–compatible field 1330 – Scenario 1*
1600 – Tea and Video Debrief
pack. Only one DCS set is needed per casualty for planning 1630 – Mission Brief for Scenario 2
purposes, and it now has its own NSN: 6545-99-959-1062. 1700 – Team Depart
Wednesday
Communication 0830 – CRM 2 – Human Factors and Evaluation
0900 – Equipment – Oxygen, Blood, and the DCS Set
Communication both within and without any resuscitation 0930 – TCCC R1 Update
1000 – Coffee
surgical team is deemed to be vital for positive medical out- 1030 – Scenario 2 †
comes. In a noisy environment, it becomes much more diffi- 1400 – Late Lunch
cult. In an in-flight scenario in particular, emphasis is placed 1500 – Debrief Internal then External
on closed-loop communication, voice discipline, and format- 1600 – Mission Brief for Scenario 3
ted information passage. Experts on this subject often com- 1700 – Team departs
pare resuscitative surgery to the airline industry: In an in-flight Thursday
emergency the keys are to, aviate, navigate and communicate 0830 – CRM 3 – Communication and Feedback
0930 – SOST C-130 Set Up
using the nature of emergency, intentions, time remaining, and 1030 – Scenario 3 (Figure 3)
‡
special instructions (NITS) algorithm. Medically, we teach 1400 – Late Lunch
communicate, resuscitate, and operate using an initial “com- 1500 – Debrief – Internal Initially then External
mand huddle” followed by use of the TBCs algorithm (TBC = 1600 – Team Departs
Time since start of procedure, Temperature of patient, Blood Friday
given and Blood remaining [Blood gases including lactate], Co- 0830 – Hasty Mission Brief Scenario 4
0900 – Set up C130 (Dark, Head Torches Only)
agulation, Surgical plan [including bail-out options]), with the 1000 – Scenario 4
information closed-loop distributed every 10 to 15 minutes. 5 1300 – Hot Debrief and Course Overview Inval
1400 – Endex! Final Instructor Meeting to 1430
*Individually tailored to team. Eg, GSW Abdomen, moulaged using a cut-
Blood suit on a 3G Sim-man. Slow time initial R1 care, then MERT transfer to
the SOST. Reception and resuscitation, with minimal transfusion. A slow
Checklists may be the best way to remember information in transition from resuscitation to surgery, slow time decision to operate, ICU
crisis or high-stress situations. These may also include remind- hold 1 hour, transfer to R3.
†
SOST set up on ship: Two casualties. GSW groin requiring initial basic first
ers of blood adjuncts such as calcium, futility decisions to be aid. (Moulaged on responsive high-flow pumping Sim with blood reservoir.)
made early (often at the 6 red cell and 6 plasma point), and CUF/TFC for R1 care on flight deck of ship. MERT arrival to resuscitate
appropriate drug administration. An example of the UK mas- and transfer on a rotary platform back to SOST. <C> on MERT and trans-
sive transfusion checklist is shown at Figure 2. A true SOST fusion. Rapid transfusion, decision to surgery on groin for a minimum of 60
minutes. Second casualty (second Soldier from assault) arrives 30 minutes
cannot perform DCS without blood. Currently, this is deliv- into surgery, GSW chest requiring chest tube or more – if team is doing
ered by most teams using red cells and plasma administered well, this patient also requires surgery; both casualties held for 90 minutes
awaiting transfer with fluctuating vital signs and resuscitation requirements.
concurrently. Storage options such as Cryocube and Dura- ‡ C-130 Room: APU noise +, battle noise +. Embassy evacuation: 2 locations:
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cube Golden Hour Boxes are discussed on the course. The Simulated short flight. Land 1 × casualty – “the Ambassador” ankle fracture
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novel Norwegian THOR approach using fresh (or cold-stored) (live casualty) with ongoing role-play of angina, myocardial infarction – en
route to safety.
whole blood, which can deliver active platelets out to 10 days, Land to take second casualty – abdominal wound “Embassy Guard” – GSW
is covered. Many SOSTs now prescreen their members for type colon with bleeding (fecal smell generator), further 1 hour – 90-minute flight
with two casualties. Land and transfer to CCAT/CCAST, reset equipment.
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