Page 11 - JSOM Winter 2021

and Drug Administration (FDA) recognized that the additional personnel recovery (CPR) team in a far-forward austere en-
need for ventilators, on March 22, 2020 and issued guidance vironment. The authors discuss actual patient transport case
outlining a policy intended to help increase availability of rel- reviews that used multiple evacuation platforms across thou-
evant technologies. Capable of providing mechanical ventila- sands of miles of terrain. To effectively incorporate CPR per-
tion, anesthesia machines do not deliver ventilation modes and sonnel into a military transport team model, they recommend
flow capabilities commonly used outside the operating room including cross-training on equipment and formularies, famil-
(OR). A paucity of published information exists to describe iarization with CPR evacuation platforms, and mass casualty
the operation of anesthesia machines, their technological and (MASCAL) exercises that incorporate the different platforms
practical limitations, and special considerations to prevent available.
harm when repurposed. Updated Considerations for the Use
of Anesthesia Gas Machines in a Critical Care Setting During ONGOING SERIES
the Coronavirus Disease Pandemic provides technical infor- INFECTIOUS DISEASES
mation and practical guidance for the safe use of anesthesia Information on Melioidosis from the Centers for Disease Con-
machines in critically ill patients outside the OR. trol and Prevention is given.

The Myths of Uncontrolled Emergence Reactions and Con- The genus Scolopendra includes large centipedes that inhabit
sideration to Stop Mandatory, Protocolled Midazolam Coad- tropical regions of Southeast Asia and the Pacific Islands as
ministration With Ketamine: Although ketamine continues to well as South America and the Southwestern US. They are ca-
demonstrate its utility and safety in the austere and prehos- pable of inflicting clinically significant venomous Centipede
pital environment, myths persist regarding the frequency of Bites. These multilegged arthropods may enter tents or build-
behavioral disturbances and unpleasant reactions, which have ings at night in search of prey and tend to hide in bedding and
led to protocolled midazolam co-administration. The authors clothing; presentation and management are discussed.
discuss the ramifications.
The authors provide Latent TB Infection in USSOF: A Re-
2021 COMBAT MEDICAL CARE CONFERENCE fresher and Update to the management of latent TB infection
in US Special Operations Forces to optimize medical readiness
Abstracts are presented from “Now, more than ever”: The Vir- through targeted testing and short treatment regimens.
tual Combat Medical Care Conference 2021 in a Pandemic
Setting.
INJURY PREVENTION
CASE REPORTS High-intensity functional training (HIFT) involves high-
In the first report of a whole blood transfusion through an volume and high-intensity physical activities with short rest
iliac crest IO for hemorrhagic shock in the military prehospital periods between movements and the use of multiple-joint
setting, Prehospital Iliac Crest Intraosseous Whole Blood Infu- exercises. Injuries During High-Intensity Functional Training
analyzes narrative and systematic reviews covering studies of
sion presents a case of whole blood transfusion via iliac crest
IO in a 50-year-old patient who was injured by a vehicle borne injuries sustained during HIFT. Two narrative and six system-
improvised explosive device (VBIED) and subsequently devel- atic reviews on injuries during HIFT were identified. Seven
oped hemorrhagic shock. Peripheral access could not be estab- reviews concluded that the injury incidences or injury rates
lished due to injury and subsequent tourniquet application on during HIFT were similar to those of comparable sports and
all four limbs. Cervical and upper thoracic trauma precluded exercise programs.
sternal placement. LTCSO+WB was administered through an
iliac crest IO, which improved hemodynamic status. SNAKEBITE ENVENOMATION MANAGEMENT
Asclepius Snakebite Foundation Update is presented.
Use of Walking Blood Bank at Point of Injury During Com- THERE I WAS
bat Operations: A Case Report reviews one case of successful
transfusion using Walking Blood Bank procedures at point Ultramobile Surgical Set for Austere Damage Control Sur-
of injury during combat. It highlights not only the feasibility, gery describes an equipment list for an ultramobile, surgeon-
but also the necessity, for implementation of this practice on carried equipment set that is specifically designed for missions
a larger scale. that require the extremes of constraints on personnel and re-
sources conducted outside the ring of golden hour access to
damage control surgery capabilities.

Layout of the
entire surgical
equipment set.

PC-12 layout. TCCC UPDATES
Fluid Resuscitation in Tactical Combat Casualty Care: TCCC
Casualty Evacuation (CASEVAC) Platform Review and Case
Series of US Military Enroute Critical Care Team With Con- Guidelines Change 21-01 4 November 2021 and The Man-
tract Personnel Recovery Services in an Austere Environment agement of Abdominal Evisceration in Tactical Combat
is a retrospective review on the interoperability of the expedi- Casualty Care: TCCC Guideline Change 20-02 provide the
tionary resuscitative surgical team (ERST) and a contracted latest changes.

In This Issue | 9