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Keywords: hemorrhage, junctional; tourniquet, junctional; Roberts T, Grubbs S, Dudewicz D, Setka n, Bay C, Wendelken
Combat Ready Clamp; Junctional Emergency Treatment ME, Izadjoo MJ
Tool; Tactical Combat Casualty Care Committee; hemor- ABSTRACT: This study focused on a clinically relevant health-
rhage control
care problem in the military: acute soft tissue wounds, or blisters.
The trial was a prospective, controlled, randomized two-arm
2016;16(2):62–66 study evaluating the efficacy of a bioelectric dressing, Procel-
Integration of Tactical Emergency Casualty Care Into the lera®, applied topically two to three times per week for 2 weeks
National Tactical Emergency Medical Support Competency to blisters developed in Ranger trainees during training at Fort
Domains Pennardt A, Callaway DW, Kamin R, Llewellyn C, Benning, Georgia. A total of 80 US Army Ranger recruits with
Shapiro G, Carmona PA, Schwartz RB blister wounds below the knee were randomly assigned to one of
ABSTRACT: Tactical emergency medical support (TEMS) is a two treatment groups (n = 40/group). The primary goal was to
critical component of the out-of-hospital response to domes- assess the clinical efficacy (rate of healing) of administered Pro-
tic high-threat incidents such as hostage scenarios, warrant cellera in conjunction with the standard-of-care (SOC) treatment,
®
service, active shooter or violent incidents, terrorist attacks, moleskin and Tegaderm , on the healing rate of blisters compared
and other intentional mass casualty-producing acts. From its with the SOC treatment alone. The secondary end points for effi-
grass-roots inception in the form of medical support of select cacy were the quantities of wound fluid biomarkers and bacterial
law enforcement special weapons and tactics (SWAT) units in bioburden. The tertiary end point was assessment of pain in the
the 1980s, the TEMS subspecialty of prehospital care has rap- treatment group compared with that of the control group during
idly grown and evolved over the past 40 years. The National the 2-week study. The results showed no statistical difference be-
TEMS Initiative and Council (NTIC) competencies and train- tween the SOC and SOC+Procellera groups in wound healing
ing objectives are the only published recommendations of their and pain. Wound fluid was reported for 24 participants (64.9%)
kind and offer the opportunity for national standardization of in the SOC group and 21 participants (56.8%) in SOC+Procel-
TEMS training programs and a future accreditation process. lera group at the baseline measurement (ρ = .475); however, the
Building on the previous work of the NTIC and the creation wounds were devoid of fluid on follow-up visits. The mild nature
of acknowledged competency domains for TEMS and the ac- of the wounds in this study was apparent by the low pain scores
knowledged civilian translation of TCCC by the Committee at the beginning of the study, which disappeared by the follow-up
2
2
for Tactical Emergency Casualty Care (C-TECC), the Joint visits. The average wound sizes were 2.2cm and 1.5cm for the
Review Committee (JRC) has created an opportunity to bring SOC and SOC+Procellera groups, respectively. This trial protocol
forward the work in a form that could be operationally useful should be conducted on open soft tissue wounds in severe heat.
in an all-hazards and whole of community format. To our knowledge, this is the first clinical study conducted within
the US Army Rangers training doctrine.
Keywords: National TEMS Initiative and Council; tactical
emergency medical support; Committee on Tactical Com- Keywords: canines; K9s; Operational K9s; Tactical Emergency
®
bat Casualty Care; incidents, domestic high-threat Casualty Care; Procellera ; dressing, bioelectric; wound,
acute; Rangers
2017;17(2):21–38
TCCC Guidelines Comprehensive Review and Update: TCCC 2017;17(2):65–73
Guidelines Change 16-03 Montgomery HR, Butler FK, Kerr W, The Role I Resuscitation Team and Resuscitative Endo-
Conklin CC, Morissette DM, Remley MA, Shaw TA, Rich TA vascular Balloon Occlusion of the Aorta Fisher AD, Teeter
WA, Cordova CB, Brenner ML, Szczepanski MP, Miles EA,
ABSTRACT: Based on careful review of the Tactical Combat Galante JM, DuBose JJ, Rasmussen TE
Casualty Care (TCCC) Guidelines, the authors developed a list
of proposed changes for inclusion in a comprehensive change ABSTRACT: The medical advancements made during the
proposal. To be included in the proposal, individual changes wars in Iraq and Afghanistan have resulted in an unprece-
had to meet at least one of three criteria: (1) The change was dented survival rate, yet there is still a significant number
primarily tactical rather than clinical; (2) the change was a mi- of deaths that were potentially survivable. Additionally, the
nor modification to the language of an existing TCCC Guide- ability to deliver casualties to definitive surgical care within
line; and (3) the change, though clinical, was straightforward the “golden hour” is diminishing in many areas of conflict.
and noncontentious. The authors presented their list to the Resuscitative endovascular balloon occlusion of the aorta
TCCC Working Group for review and approval at the 7 Sep- (REBOA) has been implemented successfully in the hospital
tember 2016 meeting of the Committee on Tactical Combat setting. REBOA may be a possible adjunct for the Role I and
Casualty Care (CoTCCC). Twenty-three items met with gen- point-of-injury (POI) care to provide temporary control of
eral agreement and were retained in this change proposal. noncompressible torso hemorrhage (NCTH) and junctional
hemorrhage. Here the authors advocate for the development
Keywords: Tactical Combat Casualty Care; TCCC; T3; Tac- of the Role I Resuscitation Team (RT) and a training pathway
tical Combat Casualty Care guidelines; TCCC Guidelines to meet the challenge of the changing battlefield
Comprehensive Review and Update; battlefield trauma
care; Role 1 Care Keywords: Tactical Combat Casualty Care; TCCC; resusci-
tation; resuscitative endovascular balloon occlusion of the
2017;17(2):49–58 aorta; REBOA; hemorrhage; shock
A Prospective Randomized Controlled Two-Arm Clinical 2017;17(2):82–88
Study Evaluating the Efficacy of a Bioelectric Dressing System Albumin for Prehospital Fluid Resuscitation of Hemorrhagic
for Blister Management in US Army Ranger Recruits Housler Shock in Tactical Combat Casualty Care Studer NM, April
GJ, Cross S, Marcel V, Kennedy DO, Husband M, Register A,
MD, Bowling F, Danielson PD, Cap AP

20 | JSOM Volume 20, Edition 4 / Winter 2020