Page 136 - JSOM Winter 2021

5. Current evidence suggests initial calcium supplementation is and a Navy undersea medical officer with more than 20 years of ex-
warranted in major trauma, especially for patients who may perience providing medical support to Special Operations Forces. Dr
require massive transfusion. At this point, there is conflict- Butler has served as the command surgeon at the US Special Oper-
ations Command and was the chairman of the Department of De-
ing evidence on the type of calcium salt administered, spe- fense’s Committee on TCCC for 11 years. He currently serves as a
cific initial dose and pursuant re-dosing recommendations. consultant to both the JTS and the CoTCCC. SO1 Terence Byrne,
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6. Many whole blood donor protocols exclude females as po- USN, is a Special Operations SEAL Medic and Special Operations
tential candidates because of concern that blood from fe- Combat Medic (SOCM). He previously served as the medical leading
male donors may entail a higher risk of transfusion-related petty officer for SOTM, Naval Special Warfare, Advanced Training
Command and is now a first-year medical student at Tulane Univer-
acute lung injury (TRALI). Given the significant number of sity. COL Andrew Cap MD, PhD, MC, USA, is the division chief,
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female service members who serve in deployed and combat Acute Combat Casualty Care Research, US Army Institute of Surgical
positions, further investigation into the donor and recipi- Research. He first trained and worked as an EMT and then as an
ent safety profiles for female whole blood transfusions are internist, hematologist, oncologist, and specialist in stem cell trans-
plantation, coagulation disorders, and transfusion medicine. He is the
required. hematology and oncology consultant to the Army Surgeon General
7. For the trauma patient in extremis, initiation of fluid resus- and has consulted extensively for the Joint Trauma System and Spe-
citation is dependent upon obtaining rapid vascular access. cial Operations Command. He serves as co-chair of the NATO Blood
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Emergent intraosseous (IO) access is twice as likely to be Panel. LTC Benjamin Donham, MD, USA, is the commander of the
successful as peripheral intravenous attempts. Optimal IO 261st Multifunctional Medical Battalion and has multiple deploy-
ments with austere surgical teams in support of overseas contingency
blood infusion strategies that will provide sufficient volume operations. Colonel Joseph J. DuBose, MD, USAF, serves as director,
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to meet resuscitation demands but that avoid the potential Center for the Sustainment of Trauma and Readiness Skills (CSTARS)
complications, such as hemolysis in the infused blood, that at R Adams Cowley Shock Trauma Center/University of Maryland in
may result from overpressurized IO infusion techniques. Baltimore, Maryland. Col DuBose is a professor of surgery at USUHS
and the University of Maryland and is board certified in general sur-
Further research is needed to help develop improved rec- gery, vascular surgery, and surgical critical care. He has over 230
ommendations for prehospital IO infusion strategies. published peer review publications as an active-duty military surgeon
with the United States Air Force and has deployed seven times as a
trauma surgeon to combat theaters in both conventional and JSOC
Acknowledgments roles. MAJ Andrew D. Fisher, MD, PA-C, ARNG, is a physician as-
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The authors gratefully acknowledge the research assistance sistant in the Texas Army National Guard, a recent graduate from the
provided by Mrs Danielle Davis of the Joint Trauma System. Texas A&M University College of Medicine, and a general surgery
The authors also thank the Department of Defense Trauma resident at the University of New Mexico School of Medicine. He pre-
Registry for providing much of the casualty data discussed in viously served on active duty as a physician assistant within USASOC.
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this paper. RDML James Hancock, MD, USN, is an emergency physician with
multiple combat deployments. He has served as a flight surgeon, as
OIC of a fleet surgical team and as OIC of a shock trauma platoon.
Disclaimers He is currently serving as the Medical Officer of the Marine Corps/
The opinions or assertions contained herein are the private director, Health Services, Headquarters Marine Corps with additional
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views of the authors and are not to be construed as official or duty as the Chief of the Medical Corps for the Navy. LCDR Victor
as reflecting the views of the Defense Health Agency or the De- Jourdain, MD, USN, is an emergency medicine physician and senior
medical officer at the Naval Medical Center San Diego Emergency
partment of Defense. This recommendation is intended to be Department. As a Fleet Marine Force qualified officer, he completed
a guideline only and is not a substitute for clinical judgment. multiple combat deployments in support of Role 1 and Role 2 eche-
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lons of care. LTC Ryan Knight, MD, USA, was an infantry platoon
leader, leading platoons in Afghanistan and Iraq, prior to becoming
Disclosures a physician. As an emergency physician he served seven years at Ft.
The authors have no disclosures to report. Bragg, NC deploying numerous times to Afghanistan and austere lo-
cations in Africa with a Joint Task Force. He has extensive experience
Release training medics, APPs, and physicians in austere/operational medicine.
th
This document was reviewed by the Director of the Joint Ryan is currently serving as the regimental surgeon for the 75 Ranger
Trauma System and by the Public Affairs Office and the Oper- Regiment and is the primary author of the 2019 and 2020 Ranger
Medic Handbooks. CAPT Lanny Littlejohn, MD, USN, is a prior US
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ational Security Office at the DoD’s Defense Heath Agency. It Marine who now serves as an emergency physician for the US Navy.
is approved for unlimited public release. He has served as a flight surgeon, diving medical officer, shock trauma
platoon leader, and command surgeon for multiple US Marine Corps
and US Special Operations command units. He is currently the force
surgeon for Naval Special Warfare Command. Colonel Matthew J.
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Martin, MD, US Army (retired), is a trauma and acute care surgeon
1 CAPT Travis Deaton, MD, USN, is the 1st Marine Division surgeon at Scripps Mercy Hospital and the Navy Medical Center San Diego.
and most recent chair of Emergency Medicine at Naval Medical Center He recently retired from active military service as the trauma director
San Diego. As a prior flight surgeon and dive medical officer, he has 13 and director of surgical research at Madigan Army Medical Center,
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deployments in support of USMC and SOCOM units. CDR Jonathan where he established and directed a highly productive basic science
Auten, DO, USN, is the program director of the Emergency Medicine and translational trauma research lab. He served in a variety of clin-
Residency at Naval Medical Center San Diego. He has served as a car- ical and leadership positions during five deployments in support of
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rier airwing flight surgeon, US Marine Corps shock trauma platoon combat operations in Iraq and Afghanistan. HMC Kevin Toland,
leader, and detachment OIC for SOUTHCOM humanitarian efforts. USN, is a Special Operations independent duty corpsman (SOIDC)
He has a wide area of research involvement in prehospital and austere and advanced tactical paramedic (ATP). He is currently serving as a
medicine with specific interests in pediatric trauma, hemostatic resus- Special Operations combat medic (SOCM) course instructor and is
citation and intraosseous blood transfusion. Maj Richard Betzold, the NCOIC of the Prolonged Casualty Care (PCC) section. He has
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MD, USAF, is a trauma surgeon who has multiple deployments with deployed multiple times in both conventional and SOF roles. CAPT
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the Joint Special Operations Command. He currently works at the Brendon Drew, DO, USN, is the Chair of the Joint Trauma System
R Adams Cowley Shock Trauma Center and is an instructor in the Committee on Tactical Combat Casualty Care. He currently serves
Air Force Center for Sustainment of Trauma and Readiness Skills pro- as the I Marine Expeditionary Force Surgeon. He has 8 deployments
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gram. CAPT (Ret) Frank Butler, USN, was a Navy SEAL platoon across Asia, Afghanistan, Iraq, Africa and 11 ships in support of both
commander before becoming a physician. He is an ophthalmologist USMC and SOCOM units.
134 | JSOM Volume 21, Edition 4 / Winter 2021