Page 16 - JSOM Fall 2020

acetaminophen should be considered as an addition to the US forcing them to rely on alternative methods for field steril-
Special Operations Command Tactical Trauma Protocols and ization of medical equipment. This literature review proposes
supplied to medics for use in field care. several alternative methods for both sterilization and disinfec-
tion of medical instruments after use and cleaning of skin and
2015;15(3):81–85 wounds before procedures. This article reviews recommenda-
PROLONGED FIELD CARE – An Ongoing Series: Tourni- tions from sources like the United Nations, the World Health
quet Conversion: A Recommended Approach in the Prolonged Organization, the Special Operations Forces Medical Hand-
Field Care Setting Brendon Drew, DO; David Bird, PA-C, book, and the Centers for Disease Control and Prevention.
MPAS; Michael Matteucci, MD; Sean Keenan, MD
2016;16(4):99–101
ABSTRACT: Life-saving interventions take precedence over Case Report – Prolonged Field Care of a Casualty With Pene-
diagnostic maneuvers in the Care Under Fire stage of Tactical
Combat Casualty Care. The immediate threat to life with an trating Chest Trauma Graham Barnhart, 18D; William Culli-
actively hemorrhaging extremity injury is addressed with the nan, 18D; Jason Pickett, MD
liberal and proper use of tourniquets. The emphasis on hemor- ABSTRACT: As Special Operations mission sets shift to re-
rhage control has and will continue to result in the application gions with less coalition medical infrastructure, the need for
of tourniquets that may not be needed past the Care Under quality long-term field care has increased. More and more,
Fire stage. As soon as tactically allowable, all tourniquets Special Operations Medics will be expected to maintain ca-
must be reassessed for conversion. Reassessment of all tour- sualties in the field well past the “golden hour” with limited
niquets should occur as soon as the tactical situation permits, resources and other tactical limitations. This case report de-
but no more than 2 hours after initial placement. This article scribes an extended-care scenario (>12 hours) of a casualty
describes a procedure for qualified and trained medical per- with a chest wound, from point of injury to eventual casualty
sonnel to safely convert extremity tourniquets to local wound evacuation and hand off at a Role II facility. This case demon-
dressings, using a systematic process in the field setting. strates the importance of long-term tactical medical consider-
ations and the effectiveness of minimal fluid resuscitation in
2015;15(3):86–93 treating penetrating thoracic trauma.
PROLONGED FIELD CARE – An Ongoing Series: Care of
the Burn Casualty in the Prolonged Field Care Environment 2017;17(1):106–120
Nicholas M. Studer, MD, EMT-P; Ian R. Driscoll, MD; Ivo- PROLONGED FIELD CARE – An Ongoing Series: Analgesia
nne M. Daly, MD, FACS; John C. Graybill, MD and Sedation Management During Prolonged Field Care Jer-
emy Pamplin, MD; Andrew D. Fisher, PA-C; Andrew Penny,
ABSTRACT: Burns are frequently encountered on the modern
battlefield, with 5%–20% of combat casualties expected to sus- 18D; Robert Olufs, 18D, ATP; Justin Rapp, 18D; Katarzyna
tain some burn injury. Addressing immediate life- threatening Hampton, MD; Jamie Riesberg, MD; Doug Powell, MD; Sean
conditions in accordance with the MARCH protocol (mas- Keenan, MD; Stacy Shackelford, MD
sive hemorrhage, airway, respirations, circulation, hypother- PURPOSE: This guideline begins where Tactical Combat
mia/head injury) remains the top priority for burn casualties. Casualty Care (TCCC) guidelines end.
Stopping the burning process, total burn surface area (TBSA)
calculation, fluid resuscitation, covering the wounds, and hypo- This Role 1, prolonged field care (PFC) guideline is intended
thermia management are the next steps. If transport to defini- to be used after TCCC Guidelines, when evacuation to higher
tive care is delayed and the prolonged field care stage is entered, level of care is not immediately possible. A provider of PFC
the provider must be prepared to provide for the complex resus- first must be an expert in TCCC. The intent of this guideline is
citation and wound care needs of a critically ill burn casualty. to identify potential issues one must consider when providing
analgesia with or without sedation for an extended time (i.e.,
4–72 hours). As a principle, the guideline attempts to decrease
2016;16(1):112–117 complexity by reducing options for monitoring, medications,
PROLONGED FIELD CARE – An Ongoing Series: Prolonged and so forth. It prioritizes experience with a limited number of
Field Care Working Group Fluid Therapy Recommendations options rather than providing recommendations about many
Benjamin Baker, DO; Doug Powell, MD; Jamie Riesberg, different options that can be used in a more customized way.
MD; Sean Keenan, MD
ABSTRACT: The Prolonged Field Care Working Group con- 2017;17(1):121–129
curs that fresh whole blood (FWB) is the fluid of choice for Review of 54 Cases of Prolonged Field Care Erik DeSoucy,
patients in hemorrhagic shock, and the capability to transfuse DO; Stacy Shackelford, MD; Joseph Dubose, MD; Seth Zwe-
FWB should be a basic skill set for Special Operations Forces ben, NREMT-P; Stephen C. Rush, MD; Russ S. Kotwal, MD,
(SOF) Medics. Prolonged field care (PFC) must also address MPH; Harold R. Montgomery, SO-ATP; Sean Keenan, MD
resuscitative and maintenance fluid requirements in nonhem- ABSTRACT: Background: Prolonged field care (PFC) is field
orrhagic conditions.
medical care applied beyond doctrinal planning timelines. As
current and future medical operations must include deliber-
2016;16(2):36–43 ate and contingency planning for such events, data are lack-
Field Sterilization in the Austere and Operational Environ- ing to support efforts. A case review was conducted to define
ment: A Literature Review of Recommendations Joshua S. the epidemiology, environment, and operational factors that
Will, DO; Shawn Alderman, MD; Robert C. Sawyer, MD affect PFC outcomes. Methods: A survey distributed to US
ABSTRACT: Special Operations Forces medical providers are military medical providers solicited details of PFC encounters
often deployed far beyond traditional military supply chains, lasting more than 4 hours and included patient demographics,

14 | JSOM Volume 20, Edition 3 / Fall 2020