Page 155 - JSOM Spring 2020

• Indigenous: Type, blood and screen for HIV . . . walking MSG Gonzalez demonstrated the one major flaw. When the
blood bank. BVM is attached and then removed, it could not be reat-
o ASVB: draw from them prior to mission and put in tached. This is a critical failure, because the green attach-
blood box. ment stays in BVM and will not allow for reattachment.
This then forced the medic to blow air in the tube with his
Q11: Are you using any warming devices? mouth. There was discussion on how manufacture changed
A11: We used the “Buddy Light” but do not like them but the design of the Cric-Key after being recommended by
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are looking at new products. CoTCCC. When they talked with the company represen-
*British officer commented on the CRASH 3 trial. tative, Chris Murphy, he stated, “They were instructed to
have BVM rotatable.”
Q12: Has the Ranger regiment implemented any new
training due to this case?
A12: No, but the medical officer and sergeant are planning
on making personnel aware of this type of injury for the
future.

Q13: Was the patient conscious?
A13: No
Critical Failure:
Q14: What was your goal for resuscitation when adminis- Green insert failure
tering blood?
A14: Trying for a radial pulse.
Q15: How aggressive were you in blood sweeping in the
eye and were you worried about a fracture of the eye
socket?
A15: I was tentative because this is not a common injury.
Q16: How aggressive in packing?
A16: I packed to the bone.
Q17: How much gauze was used?
A17: One hemostatic gauze.
Q18: CAPT Timby agrees with comments on blood warmer
but asks why are we still using it? Harold “Monty” Montgomery stated that the Cric-Key
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A18: No better option presently. is only the “grey” part (bougie) of the “Control Cric-Key”
kit and only the Cric-Key component was CoTCCC-
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*Brad Bennet followed up by stating, “The IDF are using recommended in 2013. However, one cannot purchase just
the Quinn Flow Warrior (NAR Quantum). AFMES – did a the Cric-Key , you have to purchase the whole Control
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review and it did not meet standard. The NAR Quantum is CricKey kit. In addition, he stated that when the CoTCCC
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also available but has not had an independent evaluation.”
voted on this device they made it a requirement to include
Q19: What would you change for TCCC? the bougie and that the product was approved before the
A19: Awareness final product was delivered. In the future we need to be
more rigid on standards and get out to the business of
There were numerous comments from the attendees, one by recommending products. MSG Gonzalez was asked what
Dr Jay Johannigman stated that, “one should pack the eye the Ranger regiment is now using; he said a homemade kit
socket if the eye is completely gone.” Dr Butler stated we comprised of an ET and scalpel.
are going to have to change the TCCC outlines to reflect
this kind of injury. He went on further to explain how there Further discussion by attendees brought up the point that
are people who literally take and translate the Bible saying, they will need to relook at this capability for training; both
“to pluck out your eye” and have died from hemorrhaging. the SIM Center OIC and NEMTI representatives stated
this. Dr Dorlac reminded everyone why the CoTCCC even
SGT Patrick Murphy was awarded a specially made knife looked at these devices and referred to Dr Mabry’s paper
by Dr Frank Butler for his presentation and service to where he was able to show a 33% failure rate—this was the
country. best option at the time. Additionally, CRICs now-vs-then
. . . 90% casualties are treated by SOF medics compared to
3. Combat Medic Review of equipment: 80% treated by conventional medics.
MSG Simon Gonzalez, senior medical advisor of 75th
Ranger Regiment, reviewed all the literature and informa- MSG Simon Gonzalez also wanted address the use of
tion collected at the Ranger regiment and they have banned Dsuvia by the Ranger regiment. There were some issues
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the purchase of the “Cric-Key ” after second occurrence of in ordering oral transmucosal fentanyl because DoD was
a critical design failure on a real-world casualty. Addition- removed by prime vendor for purchase, so the regiment
ally, they are very expensive, $291.99 each, compared to looked into the use of TM sufentanil (Dsuvia). One note
other kits that are available at approximately $50.00 each. is that Dsuvia is three times more expensive than TM fen-
The cost makes it prohibitive to train effectively. In the end tanyl. Dr Butler asked if there were any documented cases
it is the procedure not the device. of Dsuvia use. MSG Gonzalez confirmed that they have

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