Page 73 - JSOM Spring 2021

for fracture reduction. Nonmedical tasks, such as map read- CIP Statement
ing and locating gear, may also benefit from tactical lighting Research data derived from an approved Naval Medi-
research. cal Center, Portsmouth, Virginia IRB, protocol; number
NMCP.2017.0015. Animal tissue was derived from an ap-
The Tactical Combat Casualty Care (TCCC) course teaches proved IACUC protocol #NMCP.2015.0053. Use of resid-
a wide variety of medical procedures, but few of these proce- ual animal tissue was approved by the Naval Medical Center
dures are taught or practiced in low-light conditions. Given the Portsmouth, Virginia IACUC.
impact of poor lighting on casualty outcomes, the Committee
on Tactical Combat Casualty Care (CoTCCC) may choose to Funding
consider initiating training that prepares users to implement Funding was obtained via a 2017 Navy Surgeon General’s
tactical lighting effectively. This suggestion is supported by the Grant (CIP# 2017.0015).
observation that one of our participants was responsible for
four of seven torn sutures in the red-green condition, which Disclaimer
was the first condition randomly assigned to the participant. The views expressed in this publication reflect the results of re-
This participant also had extensive previous suturing experi- search conducted by the authors and do not necessarily reflect
ence on mannequins, live humans, and animal carcasses and the official policy of position of the Department of the Navy,
had previously performed medical procedures using both red Department of Defense, or the United States Government.
tactical lighting and night vision goggles. Further, this partic-
ipant subsequently tore one suture in the second round (red Disclosures
light) and tore zero sutures on the third (green light) round. The authors have indicated they have no financial relation-
While the performance of one specific participant is far from ships relevant to this article to disclose.
conclusive, these findings support and highlight the need for
training and practice in conducting medical procedures under Author Contributions
tactical lighting conditions. In this context, training and im- BPN conceived the study concept. BPN, JBM, and ACW ob-
plementation of improved tactical lighting may be of greatest tained funding. BPN and ACW recruited participants and col-
value in the Care Under Fire (CUF) and Casualty Evacuation lected the data. GJZ designed the study and analyzed the data.
(CASEVAC) phases of TCCC. BPN wrote the first draft, and all authors edited, read, and
approved the final manuscript.
Future researchers should strive to make tactical lighting test-
ing as battlefield realistic as possible, using simulated combat References
conditions and with the inclusion of relevant distractions, such 1. Calvano CJ, Enzenauer RW, Eisnor DL, Laporta AJ. Tactical
as excessive environmental noise, simulated gunfire, time pres- lighting in Special Operations medicine: survey of current prefer-
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portant to test other wavelength combinations, as the optimal 3. Luria SM, Schwartz I. Visual acuity under red vs. white illumina-
lighting in nighttime or low-light conditions may be environ- tion. U.S. Naval Medical Research Laboratory. 19(1):326.
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Conclusion medical performance: the effect of light hue on vision testing.
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The present study results suggest that red-green combination 6. Calvano CJ, Noyes B, Enzenaur RW, LaPorta AJ. Qualitative ef-
tactical lighting may confer benefit in performing intricate fects of light source upon visual detection of human packed red
medical tasks during night operations. While the suture com- blood cells (PRBC) against multi-cam flight uniform in a Special
pletion times and suture quality did not significantly differ by Operations aviation environment. Presented at Special Opera-
the lighting condition, users rated red-green lighting signifi- tions Medical Association’s Scientific Assembly and Exhibition;
Tampa, FL; 2014.
cantly higher than red-only or green-only wavelengths for ease 7. Schwartz RB, Gillis WL, Miles RJ. Orotracheal intubation in dark-
in identifying blood and instruments, and in performing a su- ness using night vision goggles. Mil Med. 2001;166(11):984–986.
turing task. Further, when asked which light color they would 8. Gellerfors M, Svensen C, Linde J, et al. Endotracheal intuba-
choose for use in low-light conditions, users overwhelmingly tion with and without night vision goggles in a helicopter and
preferred the red-green light mix. Combined, these findings emergency room setting: a manikin study. Mil Med. 2015;180(9):
1006–1010.
highlight the potential of red-green tactical lighting toward 9. Brummer S, Dickinson ET, Shofer FS, et al. Effect of night vision
providing quality medical care in nighttime conditions. goggles on performance of advanced life support skills by emer-
gency personnel. Mil Med. 2006;171(4):280–282.
Acknowledgments 10. Bilge S, Aydin A, Bilge M, et al. A study on the tactical safety of
The authors graciously thank Stephanie Gomez, MAJ Joanna endotracheal intubation under darkness. Mil Med. 2017;182(7):
Fishback, Melvina Queen, Chemely Walker, Casey Price, and e1722–e1725.
LT Grace Landers. 11. Aydin A, Bilge S, Eryilmaz M. Safest light in a combat area while
performing intravenous access in the dark. J R Army Med Corps.
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Prior Presentation 12. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible
Study data were presented at the 2017 Naval Medical Center statistical power analysis program for the social, behavioral, and
Portsmouth Academic Research Competition and the 2017 biomedical sciences. Behav Res Methods. 2007;39(2):175–191.
Military Health System Research Symposium.

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