Page 109 - JSOM Spring 2020

be unpredictable and harm other team members providing Trauma Care, https://www.innovativetrauma
assistance. care.com/)
2. Recall the canine to a safe location if able and maintain ■ Hemostatic dressings should be applied with at least
positive control. Keep collars and tactical vests on to aid 3 minutes of direct pressure (optional for XStat).
restraint and movement unless causing obvious harm (e.g., Each dressing works differently, so if one fails to
choking). control bleeding, it may be removed and a fresh
3. Try to prevent the MWD from sustaining additional wounds. dressing of the same type or a different type ap-
4. Injured MWDs should be extricated from burning vehi- plied. (Note: XStat is not to be removed in the field,
cles or buildings and moved to places of relative safety. but additional XStat, other hemostatic adjuncts, or
Do what is necessary to stop the burning process. Remove trauma dressings may be applied over it.)
all burning or smoldering harnesses, collars, vest, booties, c. The only “tourniquet” that should be considered for
goggles, and other gear. Avoid pulling away any items that massive extremity hemorrhage in an MWD is a stretch-
are melted into the canine’s skin or hair coat; cut hair (not able and elastic tourniquet such as the SWAT-T (H&H
skin) when possible to free melted object. Med Corp; https://www.swat-t.com/). The elastic, non-
5. Stop life-threatening extremity hemorrhage via placement rigid, and wide design of this type of material allows it
of a quick application circumferential pressure bandage to mold to nearly any limb size and conformation, en-
with hemostatic dressings, if tactically feasible. (Note: abling it to serve as an effective circumferential pressure
CoTCCC recommended windlass limb tourniquets de- bandage on an MWD’s limb.
signed for humans (e.g., Combat Application Tourniquet , d. Junctional tourniquets have not been evaluated in ca-
®
C-A-T; C-A-T Resources Inc., http://combattourniquet. nines and are not recommended at this time. Junctional
com; SOF Tactical Tourniquet Wide, SOFTT-W; Tactical hemorrhages should be treated with aggressive applica-
Medical Solutions, https://www.tacmedsolutions.com/) tion hemostatic dressings and direct pressure.
tend to slip distally and generally fail on MWDs because e. For external hemorrhage of the head and neck, where
of conformational differences and should not be used as the wound edges can be easily reapproximated, the
first-line therapy for hemorrhage control in MWDs. Limb iTClamp may be used as a primary option for hem-
tourniquets, generally, are not warranted to abate extrem- orrhage control. Wounds should be packed with a
ity hemorrhage in canines]. hemostatic dressing or XStat, if appropriate, prior to
6. Airway management is generally best deferred until the iTClamp application.
Tactical Field Care phase. f. The iTClamp does not require additional direct pres-
7. Priority for casualty care is always given to human com- sure, either when used alone or in combination with
batant casualties before canine casualties. The handler and other hemostatic adjuncts.
canine should travel together as a single unit when appro- ■ If the iTClamp is applied to the neck, perform fre-
priate and logistically feasible. quent airway monitoring and evaluate for an ex-
panding hematoma that may compromise the
airway. Consider placing a definitive airway if there
Basic Management Plan for Tactical Field Care
is evidence of an expanding hematoma.
1. ESTABLISH A SECURITY PERIMETER in accordance ■ DO NOT APPLY on or near the eye or eyelid (within
with unit tactical standard operating procedures and/or 1cm of the orbit).
battle drills. Maintain tactical situational awareness. 4. AIRWAY MANAGEMENT:
2. TRIAGE casualties as required. *NOTE: Human casual- a. Conscious MWD with no airway problems identified:
ties always receive priority of care over MWD casualties. ■ No airway interventions needed.
3. Massive Hemorrhage b. Unconscious MWD casualty without airway obstruction:
a. Assess for unrecognized hemorrhage and control all ■ Place unconscious in a recovery position (Note: Re-
sources of external bleeding with manual or direct pres- covery position for a canine is the sternal recum-
sure via application of hemostatic agents, pressure ban- bency/prone, if possible; alternatively, place in left/
dages, and/or wound packing as first-line intervention. right lateral recumbency).
[Note: CoTCCC-recommended windlass, limb tour- ■ Perform basic airway maneuvers:
niquets designed for humans (e.g., C-A-T, SOFTT-W) o Extend the head and neck into a straight in-line
tend to slip distally and generally fail on MWDs because position;
of conformational differences and should not be used o Grasp the tongue, gently extend out of the
as first-line therapy for hemorrhage control in MWDs]. mouth, and pull it down over the lower jaw.
b. CoTCCC-recommended hemostatic agents or adjuncts ■ Consider endotracheal intubation (ETI) to achieve
should be considered, if available. Use Combat Gauze or maintain patent airway (see Section. 4.d.).
(Z-Medica; www.z-medica.com/healthcare) as the ■ Consider using a mouth gag to keep the MWD’s
CoTCCC hemostatic dressing of choice. mouth open and prevent trauma to endotracheal
■ Alternative hemostatic adjuncts: tube. Examples of a field-expedient mouth gag
o Celox Gauze (Medtrade Products Ltd.; http:// include:
www.celoxmedical.com) or o 1–2-inch roll of medical tape;
o ChitoGauze (HemCon Medical Technologies o 2-inch–wide roll of self-adherent bandage
Inc.; http://www.hemcon.com) or (e.g., Coban /Vetrap [3M, https://www.3m
®
®
o XStat (Best for deep, narrow-tract junctional .com/]);
wounds; RevMedx, https://www.revmedx.com/) o Cutting the end off of a 3–5mL syringe tube
o iTClamp (may be used alone or in conjunction casing and securing over the upper and lower
with hemostatic dressing or XStat; Innovative canine teeth.

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