Page 17 - JSOM Fall 2020

environmental descriptors, provider training, modes of trans- used this agent frequently. Also fielded was 25% albumin,
portation, injuries, mechanism of injury, vital signs, treat- an agent that lacks coagulation factors but offers impressive
ments, equipment and resources used, duration of PFC, and volume expansion with minimal weight to carry and requires
morbidity and mortality status on delivery to the next level no reconstitution in the field. The current potential value of
of care. Descriptive statistics were used to analyze survey 25% albumin is largely overlooked. Although FDP presents
responses. Results: Surveys from 54 patients treated during an attractive future option for battlefield prehospital fluid re-
41 missions were analyzed. The PFC provider was on scene suscitation once FDA approved, this article argues that in the
at time of injury or illness for 40.7% (22/54) of cases. The interim, 25% albumin, augmented with fibrinogen concen-
environment was described as remote or austere for 96.3% trate and tranexamic acid to mitigate hemodilution effects on
(52/54) of cases. Enemy activity or weather also contributed coagulation capacity, offers an effective volume resuscitation
to need for PFC in 37.0% (20/54) of cases. Care was provided alternative that could save lives on the battlefield immediately.
primarily outdoors (37.0%; 20/54) and in hardened nonmed-
ical structures (37.0%; 20/54) with 42.6% (23/54) of cases 2017;17(4):115–126
managed in two or more locations or transport platforms. Evaluation and Treatment of Ocular Injuries and Vision-
Teleconsultation was obtained in 14.8% (8/54) of cases. The Threatening Conditions in Prolonged Field Care Mark Reyn-
prehospital time of care ranged from 4 to 120 hours (median olds, MD, MPH; Carl Hoover, 18D; Jamie Riesberg, MD;
10 hours), and five (9.3%) patients died prior to transport to Robert Mazzoli, MD; Marcus Colyer, MD; Scott Barnes, MD;
next level of care. Conclusion: PFC in the prehospital setting is Christopher Calvano, MD; James Karesh, MD; Clinton Mur-
a vital area of military medicine about which data are sparse. ray, MD; Frank K. Butler Jr, MD; Sean Keenan, MD; Stacy
This review was a novel initial analysis of recent US military Shackelford, MD
PFC experiences, with descriptive findings that should prove
helpful for future efforts to include defining unique skillsets EXCERPT: Evaluation and treatment of ocular injuries and
and capabilities needed to effectively respond to a variety of vision-threatening conditions in a prolonged field care (PFC)
PFC contingencies. situation can be extremely challenging. These events can lead
to irreversible loss of vision with lasting effects on military
2017;17(2):74–81 service and overall quality of life. The goal of this clinical prac-
The Sole Provider: Preparation for Deployment to a Medically tice guideline (CPG) is to provide medical professionals with
essential information on the recognition and treatment of ocu-
Austere Theater Paul Corso, 18D, DMT, NREMT-P; Cristo- lar conditions when evacuation to an eye specialist is delayed.
bal Mandry, MD; Steven Reynolds, 18D, DMT
The guidelines are based on standard ophthalmic practice
ABSTRACT: The combat focus of the US Military over the adapted to address the austere or remote environment, when
past 15 years has primarily centered on the Iraq and Afghan- the “Shield and Ship” guidelines are interrupted by delayed
istan areas of operation (AOs). Thus, much human and fi- evacuation.
nancial capital has been dedicated to the creation of a robust As with all medical concerns, recognition of the problem is
medical infrastructure to support those operations. However, the first step. This is a particular challenge for ocular condi-
Special Operation Forces (SOF) are often called upon to de- tions. Comprehensive ocular evaluation is not usually possible
ploy in much more medically austere AOs. SOF medical in austere locations and training in rapid recognition of ocu-
providers operating in such environments face significant chal- lar conditions may be limited. The ocular conditions covered
lenges due to the diversity of medical threats, extremely lim- in this guideline are the most common traumatic injuries and
ited access to medical resupply, a material shortage of casualty vision-threatening conditions that require rapid identification
evacuation platforms, lack of medical facilities, and limited and treatment to prevent loss of vision. A more comprehensive
access to higher-level care providers. This article highlights the
challenges faced during a recent Special Forces deployment to review can be found in the Joint Trauma System CPG or Wil-
derness Medicine textbook.
such an austere environment. Many of these challenges can be
mitigated with a specific approach to premission training and
preparation. 2018;18(1):29–31
Case Report: The Shrail: A Comparison of a Novel Attachable
2017;17(2):82–88 Rail System With the Current Deployment Operating Table
Albumin for Prehospital Fluid Resuscitation of Hemorrhagic Joshua Dilday, DO; Maxwell Sirkin, MD; Thomas Wertin,
Shock in Tactical Combat Casualty Care Nicholas M. Studer, MD; Frances Bradley, CRNA; Jason Hiles, MD
MD, NRP; Michael D. April, MD, DPhil, MSc; F. Bowling, ABSTRACT: The current forward surgical team (FST) operat-
ATP, BHS; Paul D. Danielson, MD, FACS, FAAP; Andrew P. ing table is heavy and burdensome and hinders essential move-
Cap, MS, MD, PhD, FACP ment flexibility. A novel attachable rail system, the Shrail, has
been developed to overcome these obstacles. The Shrail turns
ABSTRACT: Optimal fluid resuscitation on the battlefield
in the absence of blood products remains unclear. Contem- a North Atlantic Treaty Organization litter into a functional
porary Combat medics are generally limited to hydroxyethyl operating table. A local FST compared the assembly of the
starch or crystalloid solutions, both of which present signifi- FST operating table with assembling the Shrail. Device weight,
cant drawbacks. Obtaining US Food and Drug Administration storage space, and assembly space were directly measured and
(FDA)-approved freeze-dried plasma (FDP) is a top casualty compared. The mean assembly time required for the Shrail was
care research priority for the US Military. Interest in this agent significantly less compared with the operating table (23.36
reflects a desire to simultaneously expand intravascular vol- versus 151.6 seconds; p ≤ .01). The Shrail weighs less (6.80kg
3
ume and address coagulopathy. The history of FDP dates to versus 73.03kg) and requires less storage space (0.019m ver-
3
the Second World War, when American expeditionary forces sus 0.323m ) compared with the current FST operating table.
The Shrail provides an FST with a faster, lighter surgical table
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