Page 20 - JSOM Fall 2020

resuscitative interventions and challenge their ability to sus- <10% group, 586 in the 11–30% group, and 281 in the >31%
tain these interventions during lengthy, dismounted movement group. The median number of ventilator-free days within the
over unimproved terrain. In this brief report, we describe our first 30 days did not vary significantly between the ketamine
experience with a novel training course designed for PFC- group and the control group: 8.5 days (interquartile range
capable medical teams to integrate their level of advanced [IQR] 1–16 days) versus 8 days (IQR 3–13 days, p = .442).
resuscitative care within a mountainous, rough terrain evac- Subjects receiving ketamine had higher mortality rates: 59.4%
uation-training program. Our goals were to identify training (n = 117) versus 40.6% (n = 80, p < .001), with an odds ra-
gaps for Special Operations Forces medical units tasked to op- tio for in-hospital mortality of 7.51 (95% CI 5.53–10.20,
erate in a cold-weather, mountain environment with limited p < .001). When controlling for TBSA category, ventilator
evacuation resources and the challenges related to maintaining days and vasopressor administration, there was no association
PFC interventions during dismounted casualty movement. between ketamine and in-hospital mortality (0.66, 0.41–1.05,
p = .08). Conclusions: When controlling for confounders, we
2019;19(2):123–126 found no difference in in-hospital mortality between the pro-
Fever of Unknown Origin in US Soldier: Telemedical Consul- longed ketamine infusion recipients versus non-recipients.
tation Limitations in a Deployment to West Africa Paul J.
Auchincloss, APA-C; Jason J. Nam, MD; Dana Blyth, MD; 2019;19(3):76–81
Gabrielle Childs, RN; Kyle Kraft, EMT-B; Paul M. Robben, Operational Advantages of Enteral Resuscitation Following
MD, PhD; Jeremy Pamplin, MD, FCCM, FACP Burn Injury in Resource-Poor Environments: Palatability of
Commercially Available Solutions David M. Burmeister, PhD;
Objective: Review the application of telemedicine support for
managing a patient with possible sepsis, suspected malaria, SPC Joshua S. Little; Belinda I. Gómez, PhD; COL Jennifer
and unusual musculoskeletal symptoms. Gurney, MD; Tony Chao, PhD; Leopoldo C. Cancio, MD;
George C. Kramer, PhD; Michael A. Dubick, PhD
Clinical Context: Regionally Aligned Forces (RAF) support-
ing US Army Africa/Southern European Task Force (USARAF/ ABSTRACT: Background: In recent combat operations, 5%
SETAF) in the Africa Command area of responsibility. Care to 15% of casualties sustained thermal injuries, which require
provided by a small Role I facility on the compound. resource-intensive therapies. During prolonged field care or
when caring for patients in a multidomain battlefield, delayed
Organic Medical Expertise: Five 68W combat medics (one is transport will complicate the challenges that already exist in
the patient); one SOCM trained 68W combat medic. No US the burn population. A lack of resources and/or vascular ac-
provider present in country. cess in the future operating environment may benefit from al-
ternative resuscitation strategies. The objectives of the current
Closest Medical Support: Organic battalion physician assis-
tant (PA) located in the USA; USARAF PA located in Italy; report are 1) to briefly review actual and potential advantages/
French Role II located in bordering West African country; caveats of resuscitation with enteral fluids and 2) to present
medical consultation sought via telephone, WhatsApp (com- new data on palatability of oral rehydration solutions. Meth-
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munication with French physician) or over unclassified, en- ods: A review of the literature and published guidelines are
crypted e-mail. reported. In addition, enlisted US military active duty Service-
members (N = 40) were asked to taste/rank five different oral
Earliest Evacuation: Estimated at 12 to 24 hours with appro- rehydration solutions on several parameters. Results and Con-
priate country clearances and approval to fly from three coun- clusions: There are several operational advantages of using
tries including French forces support approval. enteral fluids including ease of administration, no specialized
equipment needed, and the use of lightweight sachets that are
2019;19(2):77–80 easily reconstituted/administered. Limited clinical data along
Impact of Continuous Ketamine Infusion Versus Alternative with slightly more extensive preclinical studies have prompted
Regimens on Mortality Among Burn Intensive Care Unit published guidelines for austere conditions to indicate consid-
®
Patients: Implications for Prolonged Field Care Steven G. eration of enteral resuscitation for burns. Gatorade and Drip-
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Schauer, DO, MS; Michael D. April, MD, DPhil; James K. Drop were the overall preferred rehydration solutions based
Aden 3rd, PhD; Matthew Rowan, PhD; Kevin K. Chung, MD on palatability, with the latter potentially more appropriate
for resuscitation. Taken together, enteral resuscitation may
ABSTRACT: Background: The military is rapidly moving into confer several advantages over intravenous fluids for burn
a battlespace in which prolonged holding times in the field are resuscitation under resource-poor scenarios. Future research
probable. Ketamine provides hemodynamic support and has needs to identify what solutions and volumes are optimal for
analgesic properties, but the safety of prolonged infusions is use in thermally injured casualties.
unclear. We compare in-hospital mortality between intubated
burn intensive care unit (ICU) patients receiving prolonged ket- 2019;19(3)117–121
amine infusion lasting ≥7 days or until death versus controls.
Methods: We conducted a before/after cohort study of patients A SORT Plus a GHOST Equals
undergoing admission to a burn ICU with intubation within ABSTRACT: Theater Special Operations Force (SOF) medical
the first 24 hours as part of treatment for thermal burns. In planners have been using Army forward surgical teams (FSTs)
January 2012, this ICU implemented a novel continuous ket- to maintain a golden hour for US SOF during Operation
amine infusions protocol. We performed a preintervention and Freedom’s Sentinel in the form of Golden Hour Offset Surgi-
postintervention cohort analysis. Results: We identified 2394 cal Treatment Teams (GHOST-Ts) in Afghanistan. Recently,
patients meeting our inclusion criteria—475 in the ketamine the Special Operations Resuscitation Team (SORT) was de-
group and 1919 in the control group. Regarding burn total signed to decompress and augment a GHOST-T to help ex-
body surface area (TBSA) involvement, there were 1533 in the tend a golden hour ring in key strategic locations. This article

18 | JSOM Volume 20, Edition 3 / Fall 2020