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points highlighted included the importance of early recogni-  References
          tion of hemorrhage, rapid initiation of blood-product transfu-  1.  Kisat M, Morrison JJ, Hashmi ZG, Efron DT, Rasmussen TE,
          sion, and early notification to the off-site attending surgeon to   Haider AH. Epidemiology and outcomes of non-compressible
          mobilize OR resources. The risks and benefits of REBOA were   torso hemorrhage. J Surg Res. 2013;184(1):414–421.
          discussed, and the oversight of the telemedicine intensivist was   2.  Alarhayem AQ, Myers JG, Dent D, et al. Time is the enemy:
          seen as a clear benefit given the set-up of coverage on the ICU.  mortality in trauma patients with hemorrhage from torso injury
                                                                occurs long before the “golden hour.” Am J Surg. 2016;212(6):
                                                                1101–1105.
          Relevance to Military Practice                      3.  Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on
          Eastridge et al.  and Morrison et al.  describe the significant   the battlefield: causation and implications for improving combat
                                      12
                      3
          contribution of torso hemorrhage to potentially preventable   casualty care. J Trauma. 2011;71(1 Suppl):S4–S8.
          military mortality. Eastridge et al.  reviewed 558 combat ca-  4.  Cannon J, Morrison J, Lauer C, et al. Resuscitative endovascular
                                     3
          sualties who died of wounds, finding that 51.4% were po-  balloon occlusion of the aorta (REBOA) for hemorrhagic shock.
                                                                Mil Med. 2018;183(suppl 2):55–59.
          tentially survivable, of whom 48% had NCTH as the source   5.  Brenner M, Inaba K, Aiolfi A; AAST AORTA Study Group, et
          of hemorrhage. One method to potentially decrease military   al. Resuscitative endovascular balloon occlusion of the aorta and
          mortality  is  to  bring  in-hospital  interventions  such  as  RE-  resuscitative thoracotomy in select patients with hemorrhagic
          BOA close to the point of injury. Examples of such scenar-  shock: early results from the American Association for the Sur-
          ios include supervision of the Role 2 nonphysician clinician   gery of Trauma’s Aortic Occlusion in Resuscitation for Trauma
          (including paramedics and physician assistants) and austere   and Acute Care Surgery Registry. J Am Coll Surg. 2018;226(5):
                                                                730–740.
          surgical teams.  In addition, there are discussions about the   6.  Butler FK Jr, Holcomb JB, Shackelford S, et al. Advanced Resusci-
                      13
          potential use during tactical medevac by retrieval teams, such   tative Care in Tactical Combat Casualty Care: TCCC Guidelines
          as the British military’s Medical Emergency Response Team–  Change 18-01:14 October 2018. J Spec Oper Med. 2018;18(4):
          Enhanced and similar helicopter-based platforms.  However,   37–55.
                                                 14
          this time-critical HALO intervention is complex, and we are   7.  Hatchimonji JS, Sikoutris J, Smith BP, et al. The REBOA dissipa-
          challenged with how we can ensure safety and supervision   tion curve: training starts to wane at 6 months in the absence of
                                                                clinical REBOA cases. J Surg Educ. 2020;77(6):1598–1604.
          to less-experienced clinicians outside well-resourced centers.   8.  Ribeiro MAF Jr, Feng CYD, Nguyen ATM, et al. The complica-
          Members of these teams may have been trained in REBOA   tions associated with resuscitative endovascular balloon occlusion
          prior to deployment but may be required to perform the pro-  of the aorta (REBOA). World J Emerg Surg. 2018 May 11;13:20.
          cedure for the first time several months later. This can lead   9.  Qasim ZA, Sikorsky RA. Physiologic considerations in trauma
          to deterioration of skills and lack of confidence in ability to   patients undergoing resuscitative endovascular balloon occlusion
          undertake the procedure. 7                            of the aorta. Anesth Analg. 2017;125(3):891–894.
                                                             10.  Wilcox ME, Adhikari NKJ. The effect of telemedicine in critically
                                                                ill patients: systematic review and meta-analysis. Crit Care. 2012;
          As the technology and infrastructure advances, telemedicine   16(4):R127.
          supervision may afford one such opportunity for prehospital   11.  Gross IT, Whitfill T, Redmond B, et al. Comparison of two tele-
          and near point-of-injury supervision. Staff at Role 3 medical   medicine delivery modes for neonatal resuscitation support: a
          treatment facilities (MTFs) may similarly benefit both from a   simulation-based randomized trial.  Neonatology. 2020;117(2):
          procedural aspect and from discussion of best clinical inter-  159–166.
          ventions during both “routine” clinical care and mass-casualty   12.  Morrison JJ, Stannard A, Rasmussen TE, Jansen JO, Tai NRM,
          events. Our case location would mimic a Role 3 or Role 4   Midwinter MJ. Injury pattern and mortality of noncompressible
                                                                torso hemorrhage in UK combat casualties. J Trauma Acute Care
          MTF; although many services were available, immediate bed-  Surg. 2013;75(2 Suppl 2):S263–S268.
          side support was by a non–attending-level physician with on-  13.  Northern DM, Manley JD, Lyon R, et al. Recent advances in aus-
          call support from the attending physician. Hence, having the   tere combat surgery: use of aortic balloon occlusion as well as
          telemedicine intensivist available allowed experienced attend-  blood challenges by special operations medical forces in recent
          ing-level supervision during the gap that the on-call physician   combat operations. J Trauma Acute Care Surg. 2018;85(1S Suppl
                                                                2):S98–S103.
          could be available at the bedside. This represents an example   14.  Reva VA, Horer TM, Makhnovskiy AI, Sokhranov MV, Samokh-
          in which clinical innovation in the civilian sector may be of   valov IM, DuBose JJ. Field and en route resuscitative endovas-
          great benefit to military practice.                   cular occlusion of the aorta: a feasible military reality? J Trauma
                                                                Acute Care Surg. 2017;83(1 Suppl 1): S170–S176.
          Disclosure
          The authors have nothing to disclose.























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