Page 54 - JSOM Summer 2023

TABLE 2 Clinical Practice Guideline (CPG) and Military Training Courses Relevant to Vascular Access
CPGs with Pertinent Information Related to Vascular Access
Name Year of Publication Pertinent Information
Tactical Combat Casualty Care 2021 Current indications for emergency field care including IV access and
treatment options once IV access has been obtained.
Naval Aviation Medical 2019 How and when to obtain vascular access via peripheral IV and IO
Treatment Protocols devices for flight paramedics.
Standard Medical Operating 2021 Peripheral IV/IO access protocol. Indications, contraindications, and
Guidelines (SMOG) for Critical procedures for how to access, not place, central venous catheters.
Care Flight Paramedic
REBOA: Resuscitative 2020 Indications, supplies, and personnel required to place REBOA.
Endovascular Balloon Generalized steps only (no specific detailed procedural checklist) on
Occlusion in the Aorta femoral arterial access.
Pre-Deployment Training Opportunities Currently Available to Both Surgeons and Non-Surgeons
Intended Population Relevant Curricula to Additional Pertinent
Name of Training for Training Vascular Access Information
Emergency War Surgery Course DoD deployed medical providers. Didactic distant learning lectures Following Part 1 of EWSC,
(EWSC) Curriculum based on JTS CPGs. and an in-person laboratory providers are divided into
Pertinent topics include managing practicum. specific courses for Part II
vascular injuries and obtaining Courses:
peripheral and central line 1. ASSET+
placement. 2. Combat Orthopedic
Trauma Surgery + (COTS)
3. Critical Skills for
Expeditionary Forces
ASSET Plus DoD trauma surgeons, orthopedic In-person lectures and cadaver/ 3-day course offered at the
surgeons, surgical subspecialties, animal model-based skills labs. DMRTI at Fort Sam Houston,
trauma PAs and nurses, and medical Pertinent skills include managing Texas.
and surgical technicians. peripheral vascular injuries and COTS+ course takes
obtaining peripheral and central applicable soft tissue/vascular
line placement. training from the ASSET+
course.
CSTARS/SMART DoD Medical Providers within USAF. Just in time and skills sustainment Offered at a baseline of every
in-person lectures and cadaver skills 2 years for skills sustainment.
labs. More commonly used as
Most often performed at partnered “just-in-time” training prior to
civilian trauma centers. deployment opportunities
Pertinent skills include managing Opportunities to be embedded
central lines, cadaver labs, arterial at civilian trauma centers.
lines, tubes. Program continues to expand
Appropriately credentialed as relationships grow with
providers can perform procedures civilian institutes.
on live patients.
Navy Trauma Training Center Navy Corpsmen, nurses, and In person/virtual lectures on No dedicated feedback periods
physicians most commonly in the REBOA, subclavian access. on procedural skills.
pre-deployment workup phase. Simulation time with team-based No validated skills checklists
learning. available.
Cadaver access with central-line No dedicated remediation
kits available for practice. time available for procedural
Appropriately credentialed skills.
providers can perform procedures
on live patients.
Army Miami Trauma Training Army medics, nurses, and physicians Just in time and skills sustainment Similar corresponding
Center most commonly in the pre- training in civilian trauma hospital experience to the Navy
deployment workup phase. including central lines and arterial Trauma Training Center.
lines.
Appropriately credentialed
providers can perform procedures
on live patients.
Tactical Combat Medical Army non-surgical physicians, nurse Primarily didactic driven. Very limited if any
Course practitioners, physician assistants, Hands-on field training. opportunity for central line
senior medics. Scant live tissue training. and arterial line placement.
ASSET = Advanced Surgical Skills for Exposure in Trauma, CSTARS = Center for the Sustainment of Trauma and Readiness Skills, DMRTI = De-
fense Medical Readiness Training Institute, DoD = Department of Defense, IO = intraosseous, IV = intravenous, JKO = Joint Knowledge Online,
SMART = Sustained Medical And Readiness Trained, USAF = United States Air Force
deployment itself. Multiple validated civilian training models relevant to our military population who are often healthier
exist, a description of which is beyond the scope of this manu- than the average critically-ill hospital patient, and cannula-
script. These authors recommend validation of a unique model tion is more likely to occur in an austere environment. Other

52 | JSOM Volume 23, Edition 2 / Summer 2023