Page 15 - JSOM Fall 2020

dangerous and manpower-intensive. All of these factors were 2,500 casualties died on the battlefield because they bled to
present in Somalia, where seven medics man aged 39 casualties death, and the only wounds these soldiers had were extrem-
for more than 14 hours before they could be evacuated. The ity wounds. While we have made major advances in medical
medics formed four or five small casualty collection areas and technology, we have not been able to decrease the number of
cared for 4 to 12 patients each. These treatment areas were deaths due to bleeding on the modern battlefield.
located in rooms and courtyards of Somali houses near one
of the downed helicopters, in some cases just a few feet from 2005;5(3)17–26
the ongoing battle. This experience is in marked contrast to Army Ranger Casualty, Attrition, and Surgery Rates for Air-
the expectation of timely evacuation that presently guides the borne Operations in Afghanistan and Iraq Russ S. Kotwal,
training for our conventional military medics. Future urban MD, MPH; David E. Meyer, MD; Kevin C. O’Connor, DO;
conflicts will demand medics who are trained for prolonged Bruce A. Shahbaz, MA; Troy R. Johnson, MD; Raymond A.
care in the field. Such training is presently available only to Sterling, PA-C, MPAS; Robert B. Wenzel, MD
medics serving in special operations units.
This article originally appeared in Aviation, Space, and Envi-
EXCERPT 2: CONCLUSION: Military planners have rec- ronmental Medicine, Vol. 75, No. 10, pages 833–840. Octo-
ognized that in the future, armed conflict in urban terrain is ber 2004.
likely to be the predominate form of war. It is an extremely
violent form of combat conducted at close quarters and pro- EXCERPT: Trauma management teams, consisting of medi-
duces unique hazards and patterns of injury. Evacuation of cal officers and paramedics, augmented aircraft platforms that
casualties during urban conflict will often be delayed requiring evacuated casualties from drop zones. Of the 27 Rangers re-
exceedingly well-trained medics and corpsmen to manage mul- quiring evacuation, 19 (70%) were evacuated within 6 hours,
tiple casualties for prolonged periods. 4 (15%) within 24 hours, and 4 (15%) within 72 hours. The
third group incurred prolonged evacuation times secondary
2004;4(3):46–51 to delayed presentation and not due to a lack of evacuation
Antibiotics in Tactical Combat Casualty Care 2002 Frank assets.
Butler, MD; Kevin O’Connor, MD
2005;5(3)27–38
Previously published in MILITARY MEDICINE. 168. 11: Prehospital Management of Head Injuries for the Combat
911.2003 Medic Eric J. Chin, MD; Dan S. Mosely, MD; Troy R. John-
EXCERPT: Combat medical personnel who provide pre-hos- son, MD
pital care for their wounded teammates on the battlefield, EXCERPT: FUTURE HORIZONS As we have discussed
however, do so under conditions profoundly different from here, secondary brain insult is a major cause of further brain
those found in civilian emergency medical systems. The treat- injury in the TBI. Although there is much research into in-hos-
ment strategies that they use need to take into account the pro- pital management directed at secondary brain insult preven-
longed delays to evacuation commonly encountered in combat tion,29,47 prehospital research will likely continue to focus on
operations. There was a 15-hour delay to definitive care for correcting XABCs and validating current management prac-
most casualties in Mogadishu. Because of these differences, tices. This will especially be true for prehospital RSI of head
there has been a renewed call for antibiotics to be included in injured patients. How this applies to the prehospital combat
the care provided by combat medics when there is penetrat- environment is certainly up to debate. With the combination of
ing abdominal trauma, massive soft tissue damage, a grossly prolonged evacuation times compared to civilian models and
contaminated wound, an open fracture, or when a long delay limited resources, civilian prehospital protocols may or may
until casualty evacuation is anticipated. In acknowledgment of not be applicable. Careful consideration of all interventions in
the differences between the civilian and the military prehos- the combat environment is critical to future prehospital com-
pital settings, this recommendation has now been included in bat protocols designed to improve outcome for TBI patients.
the Prehospital Trauma Life Support Manual for battlefield The use and analysis of the Joint Theater Trauma Registry will
trauma, and it is clear that battlefield antibiotics should be be a valuable resource for military healthcare providers and
added to the care provided by combat medics. should encourage more research in this area.

2004;4(4):51
EXPEDIENT MEDIC Tourniquets: Lifesavers on the Battle-
field. Donald Parsons, PA-C, LTC (RET), Thomas Walters, PROLONGED FIELD CARE ARTICLES, NOW
PhD
This article was developed by the Combat Medic Training 2015;15(2):71–73
Directorate and dispels myths about the use of tourniquets, Rationale for Use of Intravenous Acetaminophen in Special
discusses the proper use to stop bleeding, provides training Operations Medicine Edward Scott Vokoun, MD
tips, and recommends specific types. Published in the JSOM
for widest dissemination per the request of USASOC-SG. ABSTRACT: Use of intravenous acetaminophen has increased
recently as an opioid-sparing strategy for patients undergoing
EXCERPT: Although tourniquet use is discouraged by most major surgery. Its characteristics and efficacy suggest that it
medical training programs for use in the civilian community, would a useful adjunct in combat trauma medicine. This ar-
they may be life-saving on the battlefield. The standard ap- ticle reviews those characteristics, which include rapid onset,
proach to hemorrhage control may become more difficult in high peak plasma concentration, and favorable side-effect pro-
combat because of factors like limited medical supplies, pro- file. Also discussed is the hepatotoxicity risk of acetaminophen
longed evacuation times, and the tactical situation. In Vietnam, in a combat trauma patient. It concludes that intravenous

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