Page 164 - JSOM Spring 2020

There is not a whole lot of literature describing the ideal 3. We train our medics and corpsman well, but we do
saturation in brain injury but what is out there falls into not sustain them well except for the Ranger regi-
one of two categories: ment. What are the requirements to be a surgeon
o Too little oxygen = bad in SOCOM? You have to be able to do surgery but
o Too much oxygen = bad if we don’t have any surgeons, we can’t do surgery.
It has been said that Soldiers fight because medical
The main question is what is optimal PaO2 level of TBI personnel are there but the way our current organi-
patients? zation is going, we are not going to be ready for the
o Davis et al out of San Diego County, found in next conflict. Dr Butler pointed out a book, Citizen
their study that the optimal ranges was between Soldiers, demonstrated how the medical personnel
110 and 487. Other studies have shown that were out on the battlefield with the Soldiers.
PaO2 between 200 and 300 were indicative of 4. This topic created a lot of discussion within the
a worse outcome. Shock Trauma found <100 or meeting where multiple people stated their frustra-
>200 in first 24 hours = higher mortality. Sur- tion with the situation.
prisingly the Brain Trauma Foundation has no
guidelines.
WEDNESDAY – 11 SEPTEMBER 2019:
Current JTS CPGs for both the neurosurgery and severe
head trauma recommends saturation levels between 93– Day 2: 0800 hours
95%, and for the performance improvement recommends 1. Administrative remarks and introductions:
saturation levels >93%. Prolonged field care recommends Dr Frank K. Butler, chairman of the CoTCCC, called the
saturation level of >95%. There are some discrepancies meeting to order, and gave some administrative remarks
between the current recommendations. outlining the activities of Day 2. The CoTCCC will be ob-
c. Change #3: Publish guidelines guiding the use of ben- serving the six events of 9-11 throughout the morning.
zodiazepines in the prehospital setting.
2. Senior Leader Remarks:
Benzodiazepines are currently being used to frequently Dr COL (R) Paul Cordts, started the senior leader remarks
in conjunction with ketamine. Multiple JTS case reviews with the standard disclaimers and disclosures.
and personal experience identified a lack of standard-
ized indications or standardized dosing for prehospital Dr Cordts stated, “We want to keep our GME program
benzodiazepines. with operational forces and jointness.”
It is being taught in the pipeline to administer versed in *0846: North Tower Hit – moment of silence observed*
conjunction with ketamine to avoid emergence reaction.
This topic created a lot of discussion within the meeting
We do know from literature that benzodiazepine admin- where multiple people stated their frustration with the ap-
istration to ICU patients is associated with a higher risk parent disconnect between higher ups and what is going on
of death. at the ground level.
Q1: Emergence reaction? 3. TCCC in the White House
A1: Any patient experience of waking up and saying Dr Sean P. Conley, senior physician, started his remarks
never do that to me again! with the standard disclaimers and disclosures in addition
Q2: Should we eliminate it or publish guidelines? he stated he is not speaking on behalf of the White House,
A2: Getting rid of benzodiazepines is not a realistic op- EOP, Secret Service, or any other organization.
tion. However, we do need to make it very clear on when, Dr Conley gave an UNCLASSIFIED overview of the ser-
how, and what dose to give. vices they provide.
d. ARMY: COL Shawn C. Nessen, began with standard *0903: South Tower Hit – moment of silence observed*
disclaimers and disclosures. COL Nessen stated he did
not have any problems with the current TCCC guide- 4. RAPToR Course (Resuscitation Adjuncts: Prehospital
lines and is thrilled that we took the time to give them Trans fusion & REBOA)
to the medics. Dr Zaf Qassim, emergency/critical care physician at the
1. TXA is a tool to stop bleeding that is not surgery. In University of Pennsylvania Health System, started his re-
the CRASH 2 trial the difference between the con- marks with the standard disclaimers and disclosures with
trol group and the TXA group was five patients. no financial compensation or interests. Dr Qassim is the di-
In COL Nessen’s Crazy 4 trial (prolonged field rector of the RAPToR course with MAJ Andrew D. Fisher
trial), it showed increased survival in patients that as codirector.
received TXA. However, it left in question the roll
of surgery in the patients. This trial never actually The course is designed to focus on potentially preventable
took place but was used as a demonstration. prehospital death that is being experienced with torso hem-
2. In 2015, when COL Nessen first addressed the orrhage. This has led to reports showing that about 20% of
CoTCCC every trauma patient bled out within 6 deaths in 2014 were potentially preventable, which led to
hours, usually within 2 hours. The goal is to give the Hartford Consensus and Stop the Bleed campaign with
a patient that would have died time to get to the great success but the ARC (advanced resuscitative care) ar-
surgeons. However, if there are no surgeons then ticle showed there needs to be augmentation to the TCCC
there is no help. We have to talk about the prob- guidelines by adding whole blood and REBOA (resuscita-
lems all the time! tive endovascular balloon occlusion of the aorta).

158 | JSOM Volume 20, Edition 1 / Spring 2020