Page 27 - JSOM Summer 2022

much more open to transfer from ship-to-shore to in- o Monitoring of fluid status in burn patients with urinary
tra-theater patient movement to a high-quality trauma output
care facility than I would to undertake a long-distance o Awareness of the possibility of Adult Respiratory Dis-
casualty evacuation from the ship to Kuwait. To my tress Syndrome (ARDS) in burn casualties during fluid
point — the nearest Neurosurgeon or HBO /chamber resuscitation
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to the Gulf of Oman is Duqm, Dubai, or Abu Dhabi. o Add furosemide as an intervention to treat ARDS should
The closest combination of capabilities with imbedded it occur
US Military care is the latter.” (personal communica- – Adding finger thoracostomy to the TCCC Guidelines as an
tion, CAPT Jeff Timby, 2021) alternative for the initial intervention in suspected tension
pneumothorax
Action Items for Consideration Based on This Scenario
– Add OTFC to the AMALs for Navy combatant vessels. Shipboard Combat Casualty Care Research Needs
– Add 3% or 5% hypertonic saline to the AMALs for Navy Identified or Reinforced Based on This Scenario
combatant vessels. – Is resuscitation of burn patients with plasma preferrable to
– Add pelvic binding devices to the AMALs for Navy com- crystalloid resuscitation?
batant vessels. – Can freeze-dried plasma be used to resuscitate burn patients
– Add dried plasma to the AMALs for Navy combatant vessels. with success equal to that seen in thawed or liquid plasma?
– Add hypothermia prevention wraps to the AMALs for – Is there a role for enteral resuscitation in the care of se-
Navy combatant vessels. verely burned patients, and if so, should that option be
– Add one-way valves for chest tubes to the AMALs Navy used in TCCC?
combatant vessels. – Additional options for dried plasma products should be
– Increase the amount of TXA in the AMALs for Navy com- developed, tested, FDA-approved, and procured such that
batant vessels. there will be an adequate supply for the entire US military.
– The TCCC Guidelines should acknowledge the benefit of – Decision-assist software should be developed to assist IDCs
untitered Group O whole blood in shipboard scenarios caring for trauma patients in distributed maritime opera-
such as the one described in the event that there is no access tions where there may be no nearby CRTS.
to an LTOWB Walking Blood Bank. – Develop standardized metrics to assess military medical
– All Role 1 (prehospital) military medical providers, includ- personnel on their TCCC knowledge and procedural skills
ing shipboard-based corpsmen, should be trained to exe- and to assess the retention of these items at intervals after
cute a walking blood back capability, to include drawing initial and refresher TCCC training courses.
and administering whole blood. 31 – How can telehealth techniques be optimized to assist med-
– Consider updating the guidance documents for the USN ical personnel caring for trauma victims?
fleet to require a LTOWB WBB capability (or perhaps an – Development of new technology and techniques, such as
untitered Group O WBB) on all combatant ships and re- the developmental product ResQFoam, now in clinical
flect that warm fresh LTOWB is the preferred resuscitation trials, that would could provide IDCs and other medical
fluid for casualties in hemorrhagic shock when cold-stored providers on Naval vessels with a non-surgical means of
LTOWB is not available. Guidance documents should also controlling truncal hemorrhage, should be a top research
emphasize that whole blood should be given as quickly as priority.
possible when indicated. – Further development of JTS Prolonged Casualty Care
– Add a satellite phone-based voice communications (or at Guidelines focused on shipboard casualties should be un-
least a GPS-based texting capability) so that there can be dertaken by the JTS with an emphasis on burn and blast
direct medical-to-medical communications between the ca- injuries, to include the underwater blast injury complex of
sualty ship and the LHA medical personnel. arterial gas embolism, pulmonary contusions, and gastro-
– Add the treatment of immersed blast injuries to surface intestinal barotrauma.
warfare medical training programs. – Satellite-based texting technology that claims to enable
– Implement the newly completed TCCC Tier 3 (Combat communications between GPS-capable portable devices
Medic/Corpsman) training curriculum into all military or- “anywhere in the world that there is no overhead obstruc-
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ganizations and schoolhouses that provide TCCC training tion” is now available commercially and should be eval-
to Navy and Marine Corps corpsmen. uated for use in scenarios such as this. If this technology
– Develop a TCCC Tier 4 curriculum. works as advertised, this capability could provide a direct
– Consider the addition of the following interventions dis- link for text communications between medical providers
cussed for the burn casualties in this scenario to the Tier 3 on the casualty ship and those on the LHA. Satellite phones
and/or Tier 4 TCCC curricula as well as the PCC curricula: for use by medical personnel on surface ships are another
o Extremity and torso escharotomies for the Tier 4 TCCC option, as is maritime broadband internet technology.
and Prolonged Casualty Care curricula – Expedite an Emergency Use Authorization from the FDA
o Intubation or surgical airways for casualties with 40% for a domestically manufactured dried plasma product that
or greater TBSA, even when inhalation injury is not can be produced in quantities sufficient to meet US military
suspected. If a definitive airway is required in the pre- requirements.
hospital setting, should individuals without significant – Does warm fresh LTOWB produce better clinical outcomes
intubation experi ence default to doing a cric rather than than cold-stored LTOWB?
trying to attempt an intubation via Rapid Sequence – Does LTOWB result in improved outcomes over a balanced
Intubation? component resuscitation strategy?
o Oral and enteral fluid resuscitation (defined as drinking – Does type-specific warm fresh whole blood have different
or gastric infusion of salt solutions) outcomes than fresh or cold stored LTOWB?

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