Page 18 - JSOM Fall 2020

assembly. For these reasons, it is better suited for the demands United States; USARAF PA located in a European country;
of an FST and the implementation of prolonged field care. French Role II located in nearby West African country; tele-
medical consults via e-mail, phone, or video teleconsultation.
2018;18(1):133–138 Earliest Evacuation: Estimated at 12 to 24 hours with appro-
Prehospital Medicine and the Future: Will ECMO Ever Play priate clearances.
a Role? David Macku, MSc, M; Pavel Hedvicák, MSc; John
Quinn, MD; Vladimir Bencko, MD 2018;18(2):133–135
What’s in a Rash? Viral Exanthem Versus CBRNE Exposure:
ABSTRACT: Due to the hybrid warfare currently experienced Teleconsultation Support for Two Special Forces Soldiers With
by multiple NATO coalition and NATO partner nations, the
tactical combat casualty care (TCCC) paradigm is greatly Diffuse Rash in an Austere Environment Howard D. Lee,
challenged. One of the major challenges to TCCC is the ad MD; Samuel Butterfield; Joseph Maddry, MD; Doug Powell,
hoc extension phase in resource-poor environments, referred MD; William Vasios, APA-C; Heather Yun, MD; David Fer-
to as prolonged field care (PFC) and forward resuscitative care raro, MD; Jeremy Pamplin, MD
(FRC). The nuanced clinical skills with limited resources re- Objective: Review clinical thought process and key principles
quired by warfighters and auxiliary health care professionals for diagnosing weaponized chemical and biologic injuries.
to mitigate death on the battlefield and prevent morbidity and Clinical Context: Special Operation Forces (SOF) team de-
mortality in the PFC phase represent a balance that is still un- ployed in an undisclosed, austere environment.
der review. The aim of our article is to describe the connec-
tion between extracorporeal membrane oxygenation (ECMO) Organic Expertise: Two SOF Soldiers with civilian EMT-Basic
or the extracorporeal life support (ECLS) treatment and its certification.
possible improvement in prehospital trauma care, at a Role Closest Medical Support: Mobile Forward Surgical Team (2
1 or 2 facility and, more provocatively, in the PFC phase of hours away); medical consults available by e-mail, phone, or
care in the future through innovative technology and how it video-teleconsultation.
connects with FRC. We report and describe here the primary
components of ECMO/ECLS and present the main concept of Earliest Evacuation: Earliest military evacuation from coun-
a human extracorporeal circulation cocoon as a transitional try 12–24 hours. With teleconsultation, patients departed to
living form for the cardiopulmonary stabilization of wounded Germany as originally scheduled without need for Medical
combatants on the battlefield and their transportation to Evacuation.
higher echelons of care and treatment facilities (to include
damage control resuscitation [DCR] and damage control sur- 2018;18(3):120–123
gery [DCS]). As clinical governance, these matters would fall Prolonged Field Care in Support of Operation Inherent Re-
within the remit of the Committee on Surgical Combat Casu- solve, 2016 Chris Blaine, 18D; Matthew Abbott, APA-C; Eric
alty Care (CoSCCC) and the Committee on Enroute Combat Jacobson, MD
Casualty Care (CoERCCC), and it is within this framework
that we propose this concept piece of ECMO in the prehos- ABSTRACT: The authors present their experience in emer-
pital space. We caution that this report is a proposed inno- gency and long-term medical care by Special Operations
vation to TCCC but also serves to push the envelope of the Forces (SOF) medical providers in an austere environment.
PFC and FRC paradigm. What we propose will not change the In this case, a Special Forces Operational Detachment-Alpha
practice this year, but as ECMO technology progresses, it may (SFOD-A) was deployed in support of Operation Inherent Re-
change our practice within the next decade. We conclude with solve, partnered with indigenous combat forces.
proposed novel future research to save life on the battlefield
with ECMO as a major challenge and one worth the focus 2018;18(4):34–35
of further research. Medicine is controversial and constantly Use of Drone Technology for Delivery of Medical Supplies
changing; for those who work in prehospital and battlefield During Prolonged Field Care Tomaz Mesar, MD; Aaron Les-
medicine, change is the only constant on which we rely, and sig; David R. King, MD
without provocative discussion that makes our systems and ABSTRACT: Background: Care of trauma casualties in an
practice more robust, we will fail. austere environment presents many challenges, particularly
when evacuation is not immediately available. Man-packable
2018;18(1):142–144 medical supplies may be consumed by a single casualty, and
Patella Fracture in US Servicemember in an Austere Location resupply may not be possible before evacuation, particularly
Sophia Schermerhorn, BS; Paul J. Auchincloss, APA-C, MPAS; during prolonged field care scenarios. We hypothesized that un-
Kyle Kraft, EMT-B; LTC(P); Kenneth J. Nelson, MD; Jeremy manned aerial drones could successfully deliver life- sustaining
Pamplin, MD, FCCM, FACP medical supplies to a remote, denied environment where vehi-
ABSTRACT: Objective: Review the management of a patient cle or foot traffic is impossible or impractical. Methods: Using
with acute patella fracture supported by telemedical consul- an unmanned, rotary-wing drone, we simulated delivery of
tation. Clinical Context: Regionally Aligned Forces (RAF) a customizable, 4.5kg load of medical equipment, including
supporting US Army Africa/Southern European Task Force tourniquets, dressings, analgesics, and blood products. A sim-
(USARAF/ SETAF) in Africa Command area of responsibil- ulated casualty was positioned in a remote area. The flight
ity. Care was provided by a Role I facility on the compound. was preprogrammed on the basis of grid coordinates and flew
Organic Expertise: Three 68W combat medics; one Special on autopilot beyond visual range; data (altitude, flight time,
Operations Combat Medic (SOCM). Closest Medical Sup- route) were recorded live by high-altitude Shadow drone.
port: Organic battalion physician assistant (PA) located in the Delivery time was compared to the known US military stan-
dards for traversing uneven topography by foot or wheeled

16 | JSOM Volume 20, Edition 3 / Fall 2020