Page 136 - JSOM Spring 2023

Short Review of Journal Abstracts
for Casualty Care 2020–2022

Juan José Pajuelo Castro, RN*

his brief collection of articles is based on the review con- should seek innovations to extend the timelines of effectiveness
ducted since 2008 by Tactical Combat Casualty Care and to deliver novel capabilities within the timelines to the great-
T(CoTCCC), considered relevant to the tactical, operational, est extent possible. (J Trauma Acute Care Surg. 2022;93(2S Suppl):
and prehospital care communities. This publication known as S160–S164.)
“Journal watch” can be accessed through the link www.deployed
medicine.com. Prehospital tourniquets placed on limbs without major
vascular injuries, has the pendulum swung too far?
In this compilation, you will find important publications that refer
to topics that are dealt with both in training and in daily practice. Timothy Legare, MD, Rebecca Schroll, MD, John P Hunt, MD,
The focus is to present the most recent evidence from the years Juan Duchesne, MD, Alan Marr, MD, Jonathan Schoen, MD,
2020 to 2022, whose objective is none other than to serve as a MPH, Patrick Greiffenstein, MD, Lance Stuke, MD, Alison Smith,
refresher for anyone who faces patients in austere or “unconven- MD, PhD
tional” environments, although many of them can serve as guid- Am Surg. 2022; 88(9):2103–2107.
ance in prehospital and/or civilian hospital settings. Background: Combat applications of tourniquets for extremity
The evidence gathers from the importance of the correct indica- trauma have led to increased civilian prehospital tourniquet use.
tion of the tourniquet; doses, routes of administration, and results Studies have demonstrated that appropriate prehospital tourniquet
of the administration of tranexamic acid; complications from cor- application can decrease the incidence of arrival in shock with-
rect measurement and placement of the nasopharyngeal airway; out increasing limb complications. The aim of this study was to
the importance of early administration of whole blood and blood examine outcomes of prehospital tourniquet placement without
products to increase survival; the technique and correct location definitive vascular injury. Methods: Retrospective review was per-
of needle thoracostomy or the importance of preventing hypother- formed of a prospectively maintained database by the American
mia and the devices to be used for prevent it, among others. Association for the Surgery of Trauma from 29 trauma centers.
Patients in this subset analysis did not have a significant vascu-
I hope, therefore, that this work will help and improve both the lar injury as determined by imaging or intraoperatively. Patients
training and the care of our wounded warriors and patients. who received prehospital tourniquets (PHTQ) were compared to
Evidence-based principles of time, triage and treatment: patients without prehospital tourniquets (No-PHTQ). Outcomes
refining the initial medical response to massive casualty were amputation rates, nerve palsy, compartment syndrome, and
incidents in-hospital mortality. Results: A total of 622 patients had no major
vascular injury. The incidence of patients without major vascular
Stacy A. Shackelford, MD, Michael A. Remley, NRP, Sean Keenan, injury was higher in the PHTQ group (n = 585/962, 60.8 vs n =
MD, Russ S. Kotwal, MD, MPH, Jay B. Baker, MD, Jennifer Gur- 37/88, 42.0%, p < .001). Cohorts were similar in age, gender, pen-
ney, MD, Stephen Rush, MD, and Paul Friedrichs, MD etrating mechanism, injury severity scores (ISS), abbreviated injury
J Trauma Acute Care Surg. 2022;93(2S Suppl 1): S160–S164. score (AIS), and mortality (p > .05). Amputation rates were 8.3%
(n = 49/585) in the PHTQ group compared to 0% (n = 0/37) in the
Background: The overall approach to massive casualty triage has No-PHTQ group. Amputation rates were higher in PHTQ than
changed little in the past 200 years. As the military and civilian No-PHTQ with similar ISS and AIS (p = .96, p = .59). The inci-
organizations prepare for the possibility of future large-scale com- dence of nerve palsy and compartment syndrome was not different
bat operations, terrorist attacks and natural disasters, potentially (p > .05). Conclusions: This study showed a significant amount of
involving hundreds or even thousands of casualties, a modified prehospital tourniquets are being placed on patients without vas-
approach is needed to conduct effective triage, initiate treatment, cular injuries. Further studies are needed to elucidate the appropri-
and save as many lives as possible. Methods: Military experience ateness of prehospital tourniquets, including targeted education of
and review of analyses from the Department of Defense Trauma tourniquet placement.
Registry are combined to introduce new concepts in triage and ini-
tial casualty management. Results: The classification of the scale Use of haemostatic devices for the control of
of massive casualty (MASCAL) incidents, timeline of life-saving junctional and abdominal traumatic haemorrhage:
interventions, immediate first pass actions prior to formal triage a systematic review
decisions during the first hour after injury, simplification of triage
decisions, and the understanding that ultra-MASCAL will primar- Rhiannon Humphries, David N. Naumann, Zubair Ahmed
ily require casualty movement and survival needs with few prehos- Trauma Care. 2022;2(1):23–34.
pital life-saving medical interventions are discussed. Conclusion: Abstract: Catastrophic haemorrhage accounts for up to 40% of
Self aid, bystander, and first responder interventions are para- global trauma related mortality and is the leading cause of prevent-
mount and should be trained and planned extensively. Military able deaths on the battlefield. Controlling abdominal and junc-
and disaster planning should not only train these concepts, but tional haemorrhage is challenging, especially in the pre- hospital
*Correspondence to juanjopajueloc@gmail.com; spain.somc@gmail.com
Juan José Pajuelo Castro is a nurse in the Hospital Universitario La Paz Emergency Department and Special Operations Medical Coalition Inter-
national Research and Education Representative.

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