Page 35 - JSOM Fall 2020

cold stress (35°C [95°F]) to further examine the efficacy of 13. Søreide K. Clinical and translational aspects of hypothermia in
rewarming enclosure systems. major trauma patients: from pathophysiology to prevention,
• Conduct randomized controlled clinical trials by compar- prognosis and potential preservation. Injury. 2014;45:647–654.
ing passive and active external rewarming enclosure sys- 14. Forristal C, Van Aarsen K, Columbus M, et al. Predictors of hy-
tems in multiple emergency medical services regions. pothermia upon trauma center arrival in severe trauma patients
transported to hospital via EMS. Prehosp Emerg Care. 2020;24
(1):15–22.
Authorship and Contribution Statement 15. Fisher AD, April MD, Schauer SG. An analysis of the incidence
B.L.B. conceived and wrote the initial draft of this manuscript. of hypothermia in casualties presenting to emergency department
All 11 authors contributed to the development of all drafts. in Iraq and Afghanistan. Am J. Emerg Med. 2019;S0735-6757
Final approval was jointly agreed among all 11 authors and the (19)30792-2.
members of the Committee on Tactical Combat Casualty Care. 16. Joint Trauma System. Hypothermia, and Prevention, Management.
Joint Theater Trauma System Clinical Practice Guideline. 2012.
http://jts.amedd.army.mil/assets/docs/cpgs/JTS_Clinical_Practice
Financial Disclosure _Guidelines_(CPGs)/Hypothermia_Prevention_Monitoring
The authors have indicated they have no financial relationship _Management_20_Sep_2012_ID23.pdf. Accessed 15 June 2020.
to this article to disclose. 17. Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Soci-
ety Clinical Practice Guidelines for the out-of-hospital evaluation
and treatment of accidental hypothermia: 2019 update. Wilder-
Funding ness Environ Med. 2019;(4S):S47–S69.
This was no external funding for this CoTCCC Change Paper. 18. Butler FK Jr, Holcomb JB, Giebner SG, et al. Tactical combat
casualty care 2007: evolving concepts and battlefield experience.
Disclaimers Mil Med. 2007;172(suppl 11):1–19.
The opinions or assertions contained herein are the private 19. Lairet J, Bebarta VS, Maddry JK, et al. Prehospital interventions
views of the authors and are not to be construed as official or performed in afghanistan between November 2009 and March
2014. Mil Med. 2019;184(suppl 1):133–137.
as reflecting the views of the Defense Health Agency, the De- 20. Lairet JR, Bebarta VS, Burns CJ, et al. Prehospital interventions
partment of Defense, or the US Government. This recommen- performed in a combat zone: a prospective multicenter study of
dation is intended to be a guideline only and is not a substitute 1,003 combat wounded. J Trauma Acute Care Surg. 2012;73(2
for clinical judgment. suppl1):S38–S42.
21. Bennett BL, Holcomb JB. Battlefield trauma-induced hypother-
mia: transitioning the preferred method of casualty rewarming.
Disclosures Wilderness Environ Med. 2017;28 (2S):S82–S89.
J.B.H. serves on the Board of Directors of QinFlow Inc. E.M. 22. Dutta R, Kulkarni K, Steinman A, et al. Human responses to five
is the President/CEO of Aptus Volens and consults for North heated hypothermia enclosure systems in a cold environment.
American Rescue. All other authors have no disclosures to Wilderness Environ Med. 2019;30(2):163–176.
make. 23. Danzl DF, Pozos RS. Accidental hypothermia. N Engl J Med.
1994;331:1756–1760.
24. Giesbrecht GG. Cold stress, near drowning and accidental hypo-
References thermia: a review. Aviat Space Environ Med. 2001;71(7):733–752.
1. Herr RD, White GL Jr. Hypothermia: threat to military opera- 25. Brown JA, Brugger H, Boyd J, et al. Accidental hypothermia.
tions. Mil Med. 1991;156:140–144. New Engl J Med. 2012;367:1930-1938.
2. Patton BC. Cold, casualties, and conquests: the effects of cold 26. Zafren K, Giesbrecht G, Danzl D, et al. Wilderness Medical Soci-
on warfare. In: Pandolf KB, Burr RE, eds. Textbooks of Military ety Guidelines for the out-of-hospital evaluation and treatment of
Medicine: Medical Aspects of Harsh Environments. Washington, accidental hypothermia: 2014 update. Wilderness Environ Med.
DC: TMM Publications; 2002:313–349. 2014:25:S66–85.
3. Penn-Barwell J, Fries CA, Bennett PM, et al. Mortality, survival 27. Paal P, Gordon L, Strapazzon G, et al. Accidental hypothermia-
and residual injury burden of Royal Navy and Royal Marine an update: the content of this review is endorsed by the Inter-
combat casualties sustained in 11-years of operations in Iraq and national Commission for Mountain Emergency Medicine (ICAR
Afghanistan. J R Nav Med Serv. 2014;100:161–165. MEDCOM). Scand J Trauma Resusc Emerg Med. 2016;24(1):111.
4. Cannon WB, FraserJ, Cowell EM. The preventive treatment of 28. Tsuei BJ, Kearney PA. Hypothermia in the trauma patient. Injury.
wound shock. JAMA. 1918;70:618–621. 2004;35(1):7–15.
5. Jurkovich GJ. Environmental cold-induced injury. Surg Clin 29. Wolberg AS, Meng ZH, Monroe 3rd DM, et al. A systematic
North Am. 2007;87(1):247–267. evaluation of the effect of temperature on coagulation enzyme
6. Gentilello LM, Jurkovich GJ, Stark MS, et al. Is hypothermia in activity and platelet function. J Trauma. 2004;56(6):1221–1228.
the victim of major trauma protective or harmful? A randomized, 30. Martini WZ. Fibrinogen metabolic responses to trauma. Scand J
prospective study. Ann Surg. 1997;226(4):439–447. Trauma Resusc Emerg Med. 2009;17:2.
7. Holcomb J. The 2004 Fitts Lecture: current perspective on com- 31. Sherren PB, Hussey J, Martin R, et al. Lethal triad in severe
bat casualty care. J Trauma. 2005;59:990–1002. burns. Burns. 2014;40:1492–1496.
8. Arthurs Z, Cuadrado D, Beekley A, et al. The impact of hypo- 32. Weaver MD, Rittenberger JC, Patterson PD, et al. Risk factors for
thermia on trauma care at the 31st Combat Support Hospital. hypothermia in EMS-treated burn patients. Prehosp Emerg Care.
Am J Surg. 2006;191:610–614. 2014;18(3):335–341.
9. Eastridge BJ, Jenkins D, Flaherty S, et al. Trauma system de- 33. Ziegler B, Kenngott T, Fischer S, et al. Early hypothermia as risk
velopment in a theater of war: experiences from Operation factor in severely burned patients: a retrospective outcome study.
Iraqi Freedom and Operation Enduring Freedom. J Trauma. Burns. 2019;45(8):1895–1900.
2006;61:1366–1372. 34. Ehrl D, Heidekrüger PI, Rubenbauger J, et al. Impact of prehos-
10. Beekley AC. Damage control resuscitation: a sensible approach pital hypothermia on the outcomes of severely burned patients. J
to the exsanguinating surgical patient. Crit Care Med. 2008;36 Burn Care Res. 2018;39(5):S739–743.
(suppl 7):S267–S274. 35. Steele JE, Atkins JL, Vizcaychipi MP. Factors at scene and in
11. Nesbitt M, Allen P, Beekley A, et al. Current practice of thermo- transfer related to the development of hypothermia in major
regulation during the transport of combat wounded. J Trauma. burns. Ann Burns Fire Disasters. 2016;29(2):103–107.
2010;16(suppl 1):S162–S167. 36. Singer AJ, Freidman B, Modi P, et al. The effect of a commercially
12. Cap A, Hunt B. Acute traumatic coagulopathy. Curr Opin Crit available burn-cooling blanket on core body temperatures in vol-
Care. 2014;20(6):638–645. unteers. Acad Emerg Med. 2006;13(6):686–690.

Management of Hypothermia in Tactical Combat Casualty Care | 33