Page 9 - JSOM Winter 2019

training. In Pharmacokinetics of Tranexamic Acid via Intravenous,
Intraosseous, and Intramuscular Routes in a Porcine (Sus scrofa)
Hemorrhagic Shock Model, we investigated the pharmacokinetics
of TXA via IV, IO, and IM routes in a swine model of controlled
hemorrhagic shock. TXA administration via IO and IM routes
during hemorrhagic shock achieves serum concentrations neces-
sary for inhibition of fibrinolysis and may be practical alternatives
when IV access is not available.

US Special Operations Forces work by, with, and through partner
forces (PFs) to accomplish mutual objectives. Surgical teams sup-
port these forces directly and may assist in treating injuries sus-
tained by PF, based on established medical rules of engagement.
These surgical operations are often conducted in austere condi-
tions, with limited access to blood products. In Shared Blood:
Expeditionary Resuscitative Surgical Team (ERST-5) Use of Local
Whole Blood to Improve Resuscitation of Host Nation Partner
Forces, we present an innovative solution used by an expedition- Group of military personnel enlisted to the Volunteer Military Corps
ary resuscitative surgical team and Special Operations civil affairs of the Italian Red Cross after a B-Con training course.
team to partner with host nation medical personnel to improve PF
access to damage control resuscitation and surgery.

Patient with severe facial
trauma (thin black arrow)
with blood transfusing
in the background (thick
white arrow).
A team of emergency medical technicians and
medical students trained to the B-Con protocol. Genova, Italy.

ONGOING SERIES
Prehospital Whole Blood in SOF: Current Use and Future Direc- HUMAN PERFORMANCE OPTIMIZATION
tions: Presently, SOF medics have the donor support, logistical Special Operations Force (SOF) Operators, spouses, and compo-
framework, training, and equipment to deliver whole blood (WB) nent representatives were asked to describe what readiness looks
at the point of injury. However, widespread implementation will like to them and what is needed to achieve it. Their views informed
require expanded distribution and standardization of “blood a broad and deep dive into the academic and gray literature for
kits.” Additionally, SOF medical planners must put greater em- believable measures relevant to operational readiness, as given in
phasis on education and the importance of WB over crystalloids Measuring Special Operations Forces Readiness. This commen-
or colloids—as many medics continue to carry only these products tary is a synthesis of that work and provides recommendations for
out of convenience. As SOF strive to establish tactics, techniques, ways to improve “readying” strategies, practices, and outcomes to
and procedures and streamline prehospital WB delivery, we must better achieve human-based mission performance. The key modi-
constantly reassess and refine our procedures, incorporate the lat- fiers of Operator readiness are family, SOF culture and leadership,
est evidence and technology, and adapt to an evolving battlefield. and time. Recommendations are to measure SOF mission perfor-
mance to define premission Operator readiness; conceptualize
Unmanned aerial vehicles have seen expansion with their applica- mission readiness in terms of assets and not just deficits; combine
tions in many fields, including the opportunity these tools offer to experiential wisdom with that gained from the study of in-mission
improve medical care. Drones have significant potential for appli- performance and premission readiness data; establish SOF pheno-
cation in the tactical setting. New, unique applications for these types for use by all components; address emerging fields (doping,
drones are emerging constantly, but there is no standardized ap- sleep, mental toughness. spiritual readiness, moral injury); and de-
plication specifically with tactical medicine operations. The Good, velop a simple readiness index.
the Bad, and the Future of Drones in Tactical/Operational Medicine
is a review of the future possibilities of drones, the associated risks INFECTIOUS DISEASES
that drones present, and the current application of drone technol- Leprosy (Hansen’s Disease): There are few infectious diseases
ogy in the field of civilian operational/tactical medicine. that are as stigmatic and misunderstood as leprosy. Also known
as Hansen’s disease, leprosy is caused by Mycobacterium leprae
The Rise of the Stop the Bleed Campaign in Italy. The B-Con Ba- bacteria and is most commonly seen in tropical regions of the
sic 1.0 protocol is a medical training designed to teach how to world. More than 200,000 newly diagnosed cases of leprosy oc-
control massive external hemorrhages in emergency conditions. curred in 2017, the majority in South and Southeast Asia, Africa,
Spread throughout the United States since 2013, thanks to the and the Pacific Islands. In the United States, there were 178 new
Stop the Bleed campaign, it has seen a progressive international cases reported in 2015, with most cases occurring in those who
spread during 2016–2018. We report here data from the first 18 were foreign-born, primarily from Oceania. Leprosy can cause
months of our training in Italy. (continues on page 25)

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