Page 44 - JSOM Summer 2022

The JSOM Critical Care Supplement

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Andrew D. Fisher, MD, MPAS *; Brandon M. Carius, DSc, MPAS, PA-C 2

he past 20 years witnessed significant and critical im- and Rosanne Schloss for their hard work and patience during
provements in trauma medicine, especially in the pre- this process. Furthermore, we would like to thank all the re-
Thospital setting. The formation and development of viewers who volunteered during their busy schedules to help
the Committee on Tactical Combat Casualty Care provided improve the submissions. While many topics did not make it
a standardized, evidence-based guideline and training system into this supplement, our hope is that this issue begins a process
for nonmedical personnel and clinicians of all levels. Rapid of continued development into the future with increasing com-
innovation with simple medical devices significantly decreased munity contributions and additional critical care supplements.
battlefield death, such as the use of limb tourniquets, which de-
creased limb hemorrhage mortality by 67%. More advanced Thanks for reading!
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developments like the refinement of prehospital blood trans-
fusions demonstrated significant survival benefit when started Disclosure
within minutes of wounding. Despite many hospital-based The authors have nothing to disclose and received no funding
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improvements, effective prehospital medicine still offers the for this effort.
greatest opportunity for military clinicians to improve on rates
of morbidity and mortality. Disclaimer
The opinions or assertions contained herein are the private
Delivery of critical care medicine in the prehospital setting is views of the author and are not to be construed as official or
readily available in civilian emergency medical services (EMS). as reflecting the views of the University of New Mexico School
Medical evacuation (MEDEVAC) units saw the benefit of criti- of Medicine, Texas Army National Guard, Department of the
cal care paramedic level training compared to US Army combat Army, or the Department of Defense.
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medics (EMTs) assigned as flight medics. Likewise, the critical
care training and experiences afforded to Special Operations References
medics increase their knowledge and capabilities, undoubtedly 1. Butler FK. Two decades of saving lives on the battlefield: Tactical
contributing to Special Operations Forces (SOF) units demon- Combat Casualty Care Turns 20. Mil Med. 2017;182(3):e1563–
strating lower mortality rates than conventional units. 4–6 e1568. doi:10.7205/MILMED-D-16-00214
2. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Associ-
To further improve critical care performance, education is key. ation of Prehospital Blood Product Transfusion During Medical
Many choose specific areas of interest to become subject mat- Evacuation Of Combat Casualties In Afghanistan with acute
ter experts. Prehospital medicine is no different. This supple- and 30-day survival. JAMA. Oct 24 2017;318(16):1581–1591.
doi:10.1001/jama.2017.15097
ment was developed to help provide a review of topics that 3. Mabry RL, Apodaca A, Penrod J, et al. Impact of critical care-trained
may be encountered in military and civilian prehospital set- flight paramedics on casualty survival during helicopter evacuation
tings. We deliberately sought Special Operations medics and in the current war in Afghanistan. J Trauma Acute Care Surg. Aug
paramedics to team with a physician assistant or physician 2012;73(2 Suppl 1):S32–S37. doi:10.1097/TA.0b013e3182606001
to provide a review of these topics. The concept was to take 4. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating pre-
critical care and hospital-based concepts and describe them ventable death on the battlefield. Arch Surg. Dec 2011;146(12):
1350–1358. doi:10.1001/archsurg.2011.213
in a manner that the SOF medic and critical care paramedics 5. Holcomb JB, McMullin NR, Pearse L, et al. Causes of death in
will not only understand but also find engaging and useful. U.S. Special Operations Forces in the global war on terrorism:
Our hope is that these reviews will help build a foundation for 2001–2004. Ann Surg. Jun 2007;245(6):986–991. doi:10.1097/01.
further learning and improved patient care. As we have stated sla.0000259433.03754.98
elsewhere, knowledge weighs nothing in a rucksack. 6. Kotwal RS, Mazuchowski EL, Stern CA, et al. A descriptive study of
US Special Operations Command fatalities, 2001–2018. J Trauma
The initial topic list was incredibly broad. Throughout the pro- Acute Care Surg. Apr 29 2019;doi:10.1097/TA.0000000000002354
cess, the topics were narrowed based on the practicalities of
author availability as well as time and space constraints. We
sincerely hope that you enjoy this supplement and find it use- Keywords: critical care; prehospital; combat; emergency medi-
ful. We would like to thank Michelle Landers, Allison Esposito, cal services; medical evacuation

*Correspondence to Anfisher@salud.unm.edu
1 Andrew D. Fisher is with the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, and Medical Com-
mand, Texas Army National Guard, Austin, TX. Brandon M. Carius is with the Department of Emergency Medicine Madigan Army Medical
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Center, JBLM, WA.
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