Page 96 - JSOM Fall 2019

2019 SOMSA Research Abstract Selection
for Oral or Poster Presentation

ORAL ABSTRACTS warming devices, intravenous fluids, sedation, mechanical
ventilation, narcotics and antibiotics. Patients who died pre-
hospital received significantly more intubations, tourniquets,
Military Prolonged Field Care intraosseous fluids and CPR. They also received more prehos-
and Survival in Iraq and Afghanistan pital transfusions, pelvic binders and pressure dressings (NS).
Col Stacy Shackelford, USAF, MC, Director, Joint Trauma Sys- Although prehospital transfusions were rare (1%), 725 (23%)
tem, DHA Combat Support Agency, San Antonio, TX; SFC of study patients were transfused within 24 hours, including
Paul Loos, 18D, 1st SFC (A), OSW Non-Standard Medical, Ft 91 MTs (>10 units RBCs). 815 (25%) of patients received ad-
Bragg, NC; Deborah J. del Junco, PhD, Epidemiologist, Joint vanced airways and 583 (18%) ventilator support. Survival
Trauma System, DHA Combat Support Agency, San Antonio, after prehospital CPR was 1.3%.
TX; COL (Ret) Russ S. Kotwal, MC, USA, Director of Strategic
Projects, Joint Trauma System, DHA Combat Support Agency, Conclusions: PFC should target resources, technology and
San Antonio, TX; Col Edward L. Mazuchowski, USAF, MC, training to prevent death from hemorrhage. Resources to pro-
Chief, Forensic Services, Armed Forces Medical Examiner Sys- vide advanced airway and ventilator support are also needed
tem, San Antonio, TX; MSG (Ret) Harold Montgomery, ATP, in the PFC environment.
Operational Medicine Liaison, Joint Trauma System, DHA
Combat Support Agency, San Antonio, TX; LTC (P) Cord Prehospital Combat Pill Pack Administration
Cunningham, USA, MC, EMS Physician, Center for Prehos- in Iraq and Afghanistan: A Department of Defense
pital Medicine, AMEDD Center & School, San Antonio, TX; Trauma Registry Analysis
COL Jennifer Gurney, USA, MC, Chief of Trauma Systems MAJ Steven G Schauer, DO, MS (1, 2, 3); MAJ Jason F Nay-
Development, Joint Trauma System, DHA Combat Support lor, PA-C (4); LT Yousef Ahmed, MD (5); Maj Joseph K Mad-
Agency, San Antonio, TX; LTC Douglas Powell, MC, USAR, dry, MD (2, 3); MAJ Michael D April, MD, DPhil, MSc (3):
Prolonged Field Care Consultant, US SOCOM, Ft Bragg, NC; (1) US Army Institute of Surgical Research, JBSA Fort Sam
LTC Jamie Riesberg, MC, USA, Surgeon, 10th Special Forces Houston, Texas (2) 59th Medical Wing, JBSA Lackland, Texas
Group (A), Ft Carson, CO; COL (Ret) Sean Keenan, MC, (3) Brooke Army Medical Center, JBSA Fort Sam Houston,
USA, Emergency Physician, Colorado Springs, CO Texas (4) Madigan Army Medical Center, Joint Base Lewis
McChord, Washington (5) Naval Special Warfare Group
Background: Prolonged field care (PFC) is field medical care ONE, Coronado, California
applied beyond doctrinal planning timelines. In military set-
tings, delayed evacuation challenges prehospital providers, but Background: The United States (U.S.) military utilizes combat
reliable data to guide practice are sparse. The objective of this pill packs to treat the combat wounded who are still able to
study is to quantify interventions administered for traumatically fight. We compared characteristics of combat casualties receiv-
injured casualties during PFC and identify resources needed. ing combat pill packs to those not undergoing this intervention.
Methods: This retrospective cohort study selected casualties Methods: This is a secondary analysis of Department of De-
with significant injuries (max AIS>2), documented prehospi- fense Trauma Registry (DODTR) dataset from January 2007
tal care, who survived 4-72 hours of PFC or died en route to to August 2016. We searched for all subjects with documented
a surgical hospital in Iraq or Afghanistan 2007–2015. PFC pill pack use or at least one drug from the pack (acetamino-
survivors were compared with prehospital decedents on injury phen, meloxicam, moxifloxacin). We compared the character-
characteristics and prehospital care. To adjust for injury sever- istics of these subjects to those of casualties not receiving any
ity, PFC survivors were matched to prehospital decedents on of these interventions.
mechanism and type of injury and body regions with severe Results: Of 28222 subjects in the DODTR during the study
injuries (AIS>3). Multi-level logistic modeling also adjusted period, 154 (0.5%) either had documentation of pill pack ad-
for age, US military, shock, transport team, maximum AIS and ministration (n=17) or documentation of at least one pill pack
ISS. P values <0.05 were significant. drug (n=137). Recipient demographics and injury patterns

Results: Of 3,222 patients identified, 691 (21%) died pre- were comparable to those of non-recipients with most recipi-
hospital, 2,531 survived PFC. Of 804 deaths, 738 (92%) oc- ents of male sex (98.1%) and sustaining injuries by explosives
curred within 24 hours. Median time to death was 1.2 hours (61.7%). Composite injury scores were lower in recipients ver-
(IQR=0.8,8.9). PFC survivors received significantly more sus non-recipients (median 9 [4-16] versus 4 [1-9], p<0.001).

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