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2015;15(3):32–38 Keywords: burn injury; inhalation injury; Tactical Combat
The Operational Canine and K9 Tactical Emergency Casualty Casualty Care; prolonged field care; Silverlon; Water-Jel;
Care Initiative Palmer LE, Maricle R, Brenner J Burntec
ABSTRACT: Background: Approximately 20% to 25% of 2016;16(1):44–50
trauma-related, prehospital fatalities in humans are due to pre- Evaluation and Testing of Junctional Tourniquets by Special
ventable deaths. Data are lacking, however, on the nature and Operation Forces Personnel: A Comparison of the Combat
the prevalence of operational canine (OC) prehospital deaths. Ready Clamp and the Junctional Emergency Treatment Tool
It is plausible that OCs engaged in high-threat operations are
also at risk for suffering some type of preventable death. Tac- Theodoridis CA, Kafka KE, Perez AM, Curlee JB, Yperman
tical Combat Casualty Care has significantly reduced human PC, Oppermann N, Holmstroem E, Niegsch DD, Mannino
fatality rates on the battlefield. Standardized guidelines spe- A, Ramundo N
cifically for prehospital trauma care have not been developed ABSTRACT: Background: Previous research has shown that
for the OC caregiver. An initiation has been approved by the external hemorrhage from proximal leg amputations and junc-
Committee for Tactical Emergency Casualty Care to form a tional sites represents 19.2% of potentially survivable lethal
K9-Tactical Emergency Casualty Care (TECC) working group hemorrhage. A recent effort to address this problem has resulted
to develop such guidelines. Significance: The intent of the K9- in the development of various junctional tourniquets. This study
TECC initiative is to form best practice recommendations for assessed and compared two Tactical Combat Casualty Care
the civilian high-risk OC caregiver. These recommendations Committee-approved junctional tourniquets, the Combat Ready
are to focus on interventions that (1) eliminate the major Clamp (CRoC) and the Junctional Emergency Treatment Tool
causes of canine out-of-hospital preventable deaths, (2) are (JETT), to contribute to their future development and to better
easily learned and applied by any civilian first responder, and inform on the decisions for device selection by military units.
(3) minimize resource consumption. Aims of the study also were to provide concrete feedback and
suggestions on how to effectively apply the devices. Methods:
Keywords: canine; trauma; preventable death; Tactical Emer- Via a specific questionnaire, 75 international attendees of the
gency Casualty Care; K9-TECC; guidelines
International Special Training Centre Medical Branch Special
Operations Forces Advanced Medical First Responder course
2015;15(3):81–85 evaluated the CRoC and the JETT on different parameters.
Tourniquet Conversion: A Recommended Approach in the Both devices were tested objectively through timed applications
Prolonged Field Care Setting Drew B, Bird D, Matteucci M, aimed at stopping unilateral lower-extremity distal pulse on 33
Keenan S of these 75 students, verified by palpation by Medical Branch in-
ABSTRACT: Life-saving interventions take precedence over structors. Subjective and objective data were examined for mu-
diagnostic maneuvers in the Care Under Fire stage of Tactical tual correlation. Results: Users ranked the JETT higher than the
Combat Casualty Care. The immediate threat to life with an CRoC on all parameters, including effectiveness on the battle-
actively hemorrhaging extremity injury is addressed with the field (ρ < .001), ease of use (ρ < .039), speed of application (ρ <
liberal and proper use of tourniquets. The emphasis on hemor- .001), and not slipping in use (ρ < .001), although the difference
rhage control has and will continue to result in the application on other parameters such as effectiveness in hemorrhage control
of tourniquets that may not be needed past the Care Under was not statistically significant. Considering all parameters to-
Fire stage. As soon as tactically allowable, all tourniquets gether, the JETT was evaluated as a better device than the CRoC
must be reassessed for conversion. Reassessment of all tour- (ρ < .001). The application time measurement suggested that
niquets should occur as soon as the tactical situation permits, the JETT was applied faster (by approximately 15 seconds on
but no more than 2 hours after initial placement. This article average; p < .001). The fastest CRoC and JETT applications
describes a procedure for qualified and trained medical per- were 37 and 29 seconds, respectively. The JETT was not easier
sonnel to safely convert extremity tourniquets to local wound to use or more effective than the CRoC; there was a 9% fail-
dressings, using a systematic process in the field setting. ure rate of the JETT occluding a unilateral common femoral
artery. The JETT’s efficacy in occluding a unilateral common
Keywords: prolonged field care; tourniquets; tourniquet femoral artery can be compromised if the device’s pelvic binder
conversion; Tactical Combat Casualty Care is not sufficiently tightened prior to threading the T-handled
pad. The CRoC’s application time can be drastically reduced
2015;15(3):86–93 if the device is kept assembled and firm pressure is immediately
Care of the Burn Casualty in the Prolonged Field Care Envi- asserted upon placement on the intended location through the
ronment Studer NM, Driscoll IR, Daly IM, Graybill JC vertical arm, then threading the device. Both devices were ap-
ABSTRACT: Burns are frequently encountered on the modern plied safely; no adverse effects were reported during or after
battlefield, with 5%–20% of combat casualties expected to sus- application. Conclusion: Even though the JETT might be pre-
tain some burn injury. Addressing immediate life-threatening ferred by military medical providers, the CRoC still has merits.
conditions in accordance with the MARCH protocol (massive As both devices proved to occlude the arterial flow in no less
hemorrhage, airway, respirations, circulation, hypothermia/ than 54 seconds on average, they could be used to supplement
head injury) remains the top priority for burn casualties. Stop- direct pressure and wound packing, the latter two still being
ping the burning process, total burn surface area (TBSA) calcula- considered the immediate actions for inguinal bleeding control.
tion, fluid resuscitation, covering the wounds, and hypothermia Considering that the CRoC and the JETT can be applied in as
management are the next steps. If transport to definitive care is little as 37 and 29 seconds, respectively, users should be effec-
delayed and the prolonged field care stage is entered, the pro- tively trained and entirely proficient on either device to justify
vider must be prepared to provide for the complex resuscitation their election as the primary countermeasure to hemorrhage not
and wound care needs of a critically ill burn casualty. amenable to regular tourniquets.

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