Page 154 - JSOM Spring 2020

Committee on Tactical Combat Casualty Care Meeting Minutes

10–11 September 2019 – San Antonio, Texas

Dr Frank K. Butler, Chairman;
Dominique J. Greydanus

TUESDAY – 10 September 2019: constriction or clots, and 3) we were packing blindly and
Day 1 did not think there could be shrapnel imbedded.
1. Chairman’s Welcome: In the question and answer period that followed, there was
Dr Frank K. Butler, Chairman of the CoTCCC, called the great discussion.
meeting to order and thanked Mrs Danielle Davis and Mr
Dallas Burelison for their hard work to get the meeting Q1: Where were you treating him?
approved. He then asked attendees to introduce them- A1: Small Forward Operating Base (small schoolhouse), a
selves. Dr Butler briefly reviewed the CoTCCC’s progress few kilometers from the FOB.
in prehospital combat trauma care since 2001, its current *Dr Peter Rhee stated, “he had a police officer that bled
knowledge products, and its performance improvement out from a gunshot to the eye. The bleeding that killed him
methodology. He then reviewed the agenda for the meeting was not necessarily from the eye but the brain.”
and requested that any potential conflicts of interest among
the attendees be disclosed. Departing CoTCCC members Q2: Was there any facial fractures?
we recognized, as were the newly selected members who A2: No
are replacing them. Q3: How long until you achieved hemostasis?
Dr Butler announced his intention to stop down as Chair- A3: SGT Murphy could not remember the amount of time it
man of the CoTCCC following this meeting in order to took but said they packed the socket with hemostatic gauze
spend more time with his family and to make room for a and held pressure until no further bleeding was observed.
fresh perspective in the CoTCCC leadership.
Q4: Was the patient’s eye completely gone?
Dr Butler reminded all attendees on government-sponsored A4: Yes
travel to have their receipts into Ms Davis no later than 3
days after the committee completion. Q5: What was the final outcome?
A5: Unknown – the patient was alive when he was evacu-
Dr Butler thanked Mrs Danielle Davis for her 10 years of ated to a local hospital.
outstanding service to the CoTCCC, for which she received
a TCCC Special Award in the past. Q6: What was the timeline from injury to hemorrhage
control?
2. Combat Medic Presentation: A6: 20–30 minutes
SGT Patrick Murphy, medic from 2/75th Ranger Regiment,
presented a unique case involving a massive ocular hemor- Q7: What blood products were used?
rhage to an adult male local national. The individual fell A7: US medical stock and walking blood bank from indige-
from a second story building following and IED blast close nous forces. We were well stocked.
to his location. When SGT Murphy arrived the right eye, Q8: How much was used?
socket was hemorrhaging. Trying to get hemorrhage con-
trol on the unorthodox bleed (eye socket) did not involve A8: 60 units of blood and/or blood products.
using clamps or ligation but packing with hemostatic gauze Q9: What was your logistical chain for the blood?
into the eye socket and suturing the eye lids together to A9: Rangers are trained to draw and administer blood on
hold pressure. The patient received 6 units of blood and target. Prior to mission we receive blood from ASVP housed
blood products in order to adequately resuscitate the pa- in Golden Hour containers.
tient and restore his radial pulse. Q10: How do you train nonmedical personnel for blood
SGT Murphy ended his presentation with some lessons (US and indigenous)?
learned: 1) you can bleed to death from an eye injury, 2) the A10: Unit Level: Ranger medics and ROLO program (non-
use of epinephrine or TXA soaked gauze for either vessel medic draw).

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