Page 145 - JSOM Fall 2022

blood products. Furthermore, the limitations within this database SD = 5.06) to post­education self­efficacy (M = 37.94, SD = 2.10),
highlight the need for systems designed to capture medical care t (17) = –11.29, p < 0.001. A paired t­test revealed a significant
performance improvement, as this database is not designed to increase in exam scores from pre (M = 70.22, SD = 9.43) to post
support such analyses. A mandate for performance improvement (M = 87.78, SD = 7.19), t (17) = –7.31, p < 0.001. There was no
within AFRICOM that is similar to that of the US Central Com­ pre­intervention skills assessment, however, all participants (n =
mand would be beneficial if major improvements are to occur. 18, 100%) passed the tourniquet application, needle chest com­
pression, and insertion of nasopharyngeal airway. Conclusion:
Studies on the Correct Length of TCCC for Army Aviators is easily implemented, demonstrates an
Nasopharyngeal Airways in Adults: A Literature Review increase in knowledge and confidence in providing prehospital
Catharina Scheuermann-Poley, Andre Lieber care, and provides effective scenario­based training of necessary
J Spec Oper Med. Fall 2021;21(3):45–50. psychomotor skills needed to reduce preventable death on the bat­
tlefield. TCCC for Army Aviators effectively takes the TCCC for
The use of a nasopharyngeal airway (NPA) as an adjunct airway All Combatants curriculum and modifies it to address the unique
device can be critically important in emergency medicine. When considerations in treating wounded aviators and passengers, both
placed correctly, the device can prevent upper airway obstruction. in flight and after crashes. This project demonstrates on a small
The goal of our review was to learn whether there is scientific scale how TCCC can be tailored to specific military jobs in or­
evidence about the correct length and the insertion depth, and der to successfully meet the intent of the upcoming All Service
possible facial landmarks, that can predict the appropriate length Member TCCC course mandated in DoD 1322.24. Beyond Army
of the NPA. There has been no real consensus on how to measure aviation, this program is easily modifiable for aviators throughout
the appropriate tube length for the NPA. Several studies have been the military and civilian sector.
able to demonstrate correlations between facial landmarks and
body dimensions; however, we did not find any scientific evidence Prehospital Paramedic Pleural Decompression:
on this matter. The reviewed studies do not indicate evidence to A Systematic Review
support current recommended guidelines. This could potentially Kelsey Sharrock, Brendan Shannon, Carlos Garcia Gonzalez,
lead to both military and civilian emergency training programs Toby St. Clair, Biswadev Mitra, Michael Noonan,
not having the most accurate scientific information for training Mark Fitzgerald, Alexander Olaussen
on anatomic structures, and not having a better overall under­ Injury. 2021;52(10):2778–2786.
standing of intraoral dimensions. Emergency personnel should be
taught validated scientific knowledge of NPAs so as to quickly de­ Background: Tension pneumothorax (TPT) is a frequent life­
termine the correct tube length and how to use anatomic correla­ threat following thoracic injury. Time­critical decompression of
tions. This might require further studies on the correlations and the pleural cavity improves survival. However, whilst paramed­
perhaps radiographic measurements. A further approach includes ics utilize needle thoracostomy (NT) and/or finger thoracostomy
adjusting the tube to its correct length according to the sufficient (FT) in the prehospital setting, the superiority of one technique
assessment and management of the airway problem. over the other remains unknown. Aim: To determine and compare
procedural success, complications, and mortality between NT and
Implementation and Evaluation of FT for treatment of a suspected TPT when performed by para­
Tactical Combat Casualty Care for Army Aviators medics. Methods: We searched four databases (Ovid Medline,
Stephen M. Scott, Margaret J. Carman, Michael E. Zychowicz, PubMed, CINAHL and Embase) from their commencement until
Mark L. Shapiro, Nicholas A. True 25 August 2020. Studies were included if they analyzed patients
Mil Med. 2020;185(7­8):e1271–e1276. suffering from a suspected TPT who were treated in the prehos­
pital setting with a NT or FT by paramedics (or local equivalent
Introduction: The importance of developing military strategies to nonphysicians). Results: The search yielded 293 articles after du­
decrease preventable death by mitigating hemorrhage and reduc­ plicates were removed of which 19 were included for final analy­
ing time between the point of injury and surgical intervention on sis. Seventeen studies were retrospective (8 cohort; 7 case series; 2
the battlefield is highlighted in previous studies. Successful imple­ case control) and two were prospective cohort studies. Only one
mentation of Tactical Combat Casualty Care (TCCC) throughout study was comparative, and none were randomized controlled
elements of the USA and allied militaries begins to address this trials. Most studies were conducted in the USA (n = 13) and the
need. However, TCCC implementation is neither even nor com­ remaining in Australia (n = 4), Switzerland (n = 1) and Canada
plete in the larger, conventional force. Army Aviators are at risk (n = 1). Mortality ranged from 12.5% to 79% for NT and 64.7%
for preventable death as they do not receive prehospital care train­ to 92.9% for FT patients. A higher proportion of complications
ing and are challenged to render prehospital care in the austere were reported among patients managed with NT (13.7%) com­
environment of helicopter operations. Army aviators are at risk pared to FT (4.8%). We extracted three common themes from the
for preventable death due to the challenges to render prehospital papers of what constituted as a successful pleural decompression:
care in the austere environment of helicopter operations. Helicop­ vital signs improvement, successful pleural cavity access, and ab­
ters often fly at low altitudes, engage in direct action in support sence of TPT at hospital arrival. Conclusion: Evidence surrounding
of ground troops, operate at a great distance from medical facil­ prehospital pleural decompression of a TPT by paramedics is lim­
ities, typically do not have medical personnel onboard, and can ited. Available literature suggests that both FT and NT are safe for
have long wait times for medical evacuation services due to the far pleural decompression, however both procedures have associated
forward nature of helicopter operations. Materials and Methods: complications. Additional high­quality evidence and comparative
This is a quality improvement pre­post­intervention design study studies investigating the outcomes of interest is necessary to deter­
evaluating the implementation of a combat casualty care training mine if and which procedure is superior in the prehospital setting.
program for Army aviators using well­established evidence­based
guidelines for providing care to casualties on the battlefield. The Evaluating the Tactical Combat Casualty Care Principles
evaluation consisted of participants’ self­perceived confidence in in Civilian and Military Settings: Systematic Review,
providing care to a casualty and change in knowledge level in com­ Knowledge Gap Analysis and Recommendations for
bat casualty care in a pre/post­intervention design. Clinical skills Future Research
of tourniquet application, nasopharyngeal airway placement, and Rachel Strauss, Isabella Menchetti, Laure Perrier, Erik Blondal,
needle chest decompression were assessed on a pass/fail grading Henry Peng, Wendy Sullivan-Kwantes, Homer Tien, Avery
standard. Results: A total of 18 participants completed the pre­ Nathens, Andrew Beckett, Jeannie Callum, Luis Teodoro da Luz
and post­education surveys. A paired t­test showed a statistically Trauma Surg Acute Care Open. 2021;6(1):e000773.
significant increase in total composite scores from pre (M = 24.67,

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