Page 19 - JSOM Fall 2020

vehicle. Results: Four flights were performed. Data are given Third, I address the implications of the medic’s expanded role
as mean (± standard deviation). Time from launch to delivery in relationship to role and function stress and strain. Fourth, I
was 20.77 ± 0.05 minutes (cruise speed, 34.03 ± 0.15km/h; address the moral complexity related to withdrawing or with-
mean range, 12.27 ± 0.07km). Medical supplies were deliv- holding care. I conclude by briefly highlighting some of the
ered successfully within 1m of the target. The drone success- implications for future research. In explicitly engaging death
fully returned to the starting point every flight. Resupply by as a medical reality for which the medic ought to be prepared,
foot would take 5.1 hours with an average speed of 2.4km/h SOF medicine could set the foundational development for see-
and 61.35 minutes, with an average speed of 12km/h for a ing death as a valuable gift to be explored, not a failure to be
wheeled vehicle, if a rudimentary road existed. Conclusion: avoided or burden to be overcome.
Use of unmanned drones is feasible for delivery of life-saving
medical supplies in austere environments. Drones repeatedly 2019;19(1):48–51
and accurately delivered medical supplies faster than other Improvised Ground Evacuation Platforms for Austere Special
methods without additional risk to personnel or manned air- Operations Casualty Transport Ivan J. Antosh, MD; Owen L.
frame. This technology may have benefit for austere care of McGrane, MD; Ersan J. Capan, BSN; Jeffery D. Dominguez,
military and civilian casualties. MSN, CRNA; Luke J. Hofmann, DO
2018;18(4):106–110 ABSTRACT: There are no established ground medical-
Efficacy of the Abdominal Aortic Junctional Tourniquet–Torso evacuation systems within Special Operations Command
Plate in a Lethal Model of Noncompressible Torso Hemorrhage Africa (SOCAFRICA), given the austere and varied environ-
ments. Transporting the injured casualty requires ingenuity
Alicia M. Bonanno, MD; Heather E. Hoops, MD; Todd L. and modification of existing vehicles. The Expeditionary Re-
Graham, BS; Benjamin L. Davis, MD; Belinda H. McCully, suscitative Surgical Team (ERST) assigned to SOCAFRICA
PhD; Lauren N. Wilson, BS; Brianne M. Madtson, CVT; used four unconventional means for ground evacuation. This
James D. Ross, PhD
is a retrospective review of the various modes of ground trans-
ABSTRACT: Background: The Abdominal Aortic Junctional portation used by the ERST-3 during deployment with SOCA-
Tourniquet, when modified with an off-label, prototype, acces- FRICA. All hand-carried litter and air evacuation platforms
sory pressure distribution plate (AAJT-TP), has the potential to were excluded. Over 9 months, four different ground casu-
control non-compressible torso hemorrhage in prolonged field alty platforms were used after they were modified: (1) Mine-
care. Methods: Using a lethal, noncompressible torso hem- Resistant Ambush-Protected All-Terrain Vehicle (MAT-V;
orrhage model, 24 male Yorkshire swine (81kg–96kg) were Oshkosh Defense); (2) MRZR-4 (“Razor”; Polaris Industries);
randomly assigned into two groups (control or AAJT-TP). (3) nonstandard tactical vehicles, (NSTVs; Toyota HiLux); and
Anesthetized animals were instrumented and an 80% lap- (4) John Deere TH 6×4 (“Gator”). Use of all vehicle platforms
aroscopic, left-side liver lobe transection was performed. At was initially rehearsed and then they were used on missions
10 minutes, the AAJT-TP was applied and inflated to an in- for transport of casualties. Each of the four methods of ground
traabdominal pressure of 40mmHg. At 20 minutes after ap- evacuation includes a description of the talon litter setup, the
plication, the AAJT-TP was deflated, but the windlass was left necessary modifications, the litter capacity, the strengths and
tightened. Animals were observed for a prehospital time of weaknesses, and any summary recommendations for that plat-
60 minutes. Animals then underwent damage control surgery form. Understanding and planning for ground casualty evac-
at 180 minutes, followed by an intensive care unit–phase of uation is necessary in the austere environment. Although each
care for an additional 240 minutes. Survival was the primary modified vehicle was used successfully to transfer the combat
end point. Results: Compared with Hextend, survival was not casualty with an ERST team member, consideration should be
significantly different in the AAJT-TP group (p = .564), nor given to acquisition of the MAT-V medical-specific vehicle.
was blood loss (3.3L ± 0.5L and 3.0L ± 0.5L, respectively; Understanding the currently available modes of ground casu-
p = .285). There was also no difference in all physiologic pa- alty evacuation transport promotes successful transfer of the
rameters between groups at the end of the study or end of the battlefield casualty to the next echelon of care.
prehospital phase. Three of 12 AAJT-TP animals had an infe-
rior vena cava thrombus. Conclusion: The AAJT-TP did not 2019;19(1):66–69
provide any survival benefit compared with Hextend alone in Integrating Prolonged Field Care Into Rough Terrain and
this model of noncompressible torso hemorrhage. Mountain Warfare Training: The Mountain Critical Care
Course Benjamin Nicholson, MD; Jeremy Neskey, EMT-P;
2018;18(4):153–156 Ryan Stanfield, RN, BSN, CCRN, CEN, CFRN; Brandon Fet-
Adapting to Death: Clarifying the Roles of Special Operations terolf, DO; James Ersando, SOCM-Paramedic; Jason Cohen,
Combat Medics in Prolonged Field Care E. Ann Jeschke, PhD DO; Ricky Kue, MD, MPH
ABSTRACT: I suggest that Special Operations Forces (SOF) ABSTRACT: Current prolonged field care (PFC) training
medicine should explicitly acknowledge the Special Operations routinely occurs in simulated physical locations that force
combat medic’s role in attending death. This acknowledgment providers to continue care until evacuation to definitive care,
will allow researchers to evaluate and delimit the medic’s needs as based on the staged Ruck-Truck-House-Plane model. As
in relationship to an expanded set of roles that move beyond PFC- capable teams move further forward into austere envi-
life-saving care. This article comprises four sections. First, I ronments in support of the fight, they are in physical locations
provide background to my argument by exploring some as- that do not fit this staged model and may require teams to
sumptions of modern medicine and objections to exploring execute their own casualty evacuation through rough terrain.
battlefield death care. Second, I describe how I see the medic’s The physical constraints that come specifically with austere,
role expanding with the introduction of prolonged field care. mountainous terrain can challenge PFC providers to initiate

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