Page 39 - JSOM Fall 2023

Abdominal Injury,
Thoracic Injury, Humeral First Line
OR
No Usable Lower Extremity Sternal Second Line
2 Failed
FIGURE 2 Algorithm. Combat Casualty Attempt Attempts Attempt
in Need of IV IO
IO = intraosseous Vascular Access Access Access Failed Tibial IO

No Abdominal Injury, Tibial IO
No Thoracic Injury,
AND
Usable Lower Extremity

Future research should attempt to capture success rates to 16. Maddry J, Bebarta V. 177 Analysis of MEDEVAC providers and
guide and refine military medical prehospital resuscitation. procedures performed en route from point of injury to a military
treatment facility in combat. Ann Emerg Med. 2015;66(4):S63.
17. Maddry J, Bebarta V. 176 out-of-hospital en route care and
References life-saving interventions of traumatically injured combat patients
1. Remley MA, Loos PE, Riesberg JC. Prolonged Casualty Care transported by MEDEVAC from point of injury. Ann Emerg Med.
Guidelines 21 December 2021. J Spec Ops Med. 2022;22(1):18. 2015;66(4):S62–S63.
2. Nadler R, Gendler S, Benov A, et al. Intravenous access in the 18. Savell S, Mora AG, Perez CA, et al. En route intraosseous access
prehospital settings: What can be learned from point-of-injury performed in the combat setting. Am J Disaster Med. 2016;11(4):
experience. J Trauma Acute Care Surg. 2015;79(2):221–226.
225–231.
3. Maddry JK, Mora AG, Savell S, et al. Combat MEDEVAC. J 19. Maddry JK, Mora AG, Savell S, et al. Combat MEDEVAC: A
Trauma Acute Care Surg. 2016;81(5):S104–S110.
4. du Bose JJ, Martens D, Frament C, et al. Experience With Pre- comparison of care by provider type for en route trauma care in
theater and 30-day patient outcomes. J Trauma Acute Care Surg.
hospital Damage Control Capability in Modern Conflict Re- 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health Sys-
sults From Surgical Resuscitation Team Use. J Spec Oper Med. tem Research Symposium):S104–S110.
2017;17(4):68-71.
5. Bebarta V, Ervin A, Lairet J, Blackbourne L. Prehospital life- 20. Manley JD, Mitchell BJ, DuBose JJ, Rasmussen TE. A modern
case series of resuscitative endovascular balloon occlusion of the
saving interventions in patients with cardiac arrest in a combat aorta (REBOA) in an out-of-hospital, combat casualty care set-
setting—A prospective, multicenter Study [Abstract]. Abstracts ting. J Spec Oper Med. 2017;17(1):1–8.
of the 25th SAEM (Society for Academic Emergency Medicine) 21. Reeves LK, Savell SC, Maddry JK, et al. Prehospital life-saving
Annual Meeting. May 14-18, 2013. Atlanta, Georgia, USA. Acad interventions performed on pediatric patients in a combat zone:
Emerg Med. 2013;20(Suppl 1):S4-367.
6. Harcke HT, Crawley G, Mabry R, Mazuchowski E. Placement A multicenter prospective study. Ped Crit Care Med. 2020:
E407–E413.
of tibial intraosseous infusion devices. Mil Med. 2011;176(7): 22. Schauer SG, Naylor JF, April MD, et al. The first 30 months ex-
824–827. perience in the non-doctrinal operation inherent resolve medical
7. Nadler R, Gendler S, Chen J, et al. The Israeli Defense Force experi- theater. Mil Med. 2019;184(5-6):e319–e322.
ence with intraosseous access. Mil Med. 2014;179(11):1254–1257. 23. Shlaifer A, Siman-Tov M, Radomislensky I, et al. The impact of
8. Vassallo J, Horne S, Smith JE. Intraosseous access in the military prehospital administration of freeze-dried plasma on casualty
operational setting. JR Nav Med Serv. 2014;100(1):34–37. outcome. J Trauma Acute Care Surg. 2019;86(1):108–115.
9. Cooper BR, Mahoney CP, Hodgetts TJ, Mellor A. Intra-osseous 24. Travers S, Carfantan C, Luft A, et al. Five years of prolonged field
access (EZ-IO®) for resuscitation: UK military combat experi- care: prehospital challenges during recent French military opera-
ence. BMJ Mil Health. 2007;153(4):314–316.
tions. Transfusion (Paris). 2019;59(S2):1459–1466.
10. Schauer SG, Naylor JF, Maddry JK, et al. Trends in Prehospital 25. Lewis P, Wright C. Saving the critically injured trauma patient: A
Analgesia Administration by U.S. Forces From 2007 Through retrospective analysis of 1000 uses of intraosseous access. Emerg
2016. Prehosp Emerg Care. 2019;23(2):271–276. Med J. 2015;32(6):463–467.
11. Tobin JM, Nordmann GR, Kuncir EJ. Resuscitation during criti- 26. Suay RN, Cela EB, de Barbará AHA, et al. Intraosseous access for
cal care transportation in Afghanistan. J Spec Oper Med. 2015;15 fluid therapy in combat situations: use by Spanish military medi-
(3):72–75.
12. Reades R, Studnek JR, Garrett JS, et al. Comparison of first- cal staff in Afghanistan. Rev Esp Anestesiol Reanim. 2011;58(2):
85–90.
attempt success between tibial and humeral intraosseous inser- 27. Harcke HT, Crawley G, Ritter BA, Mazuchowski R. Feedback
tions during out-of-hospital cardiac arrest. Prehosp Emerg Care. to the field: an assessment of sternal intraosseous (IO) infusion.
2011;15(2):278–281.
13. Hodgetts JM, Johnston A, Kendrew J. Long-term follow-up of J Spec Oper Med. 2011;11(1):23-26.
two patients with retained intraosseous sternal needles. J R Army
Med Corps. 2017;163(3):221–222. PMID: 37490425; DOI: 10.55460/4WHG-X7ZZ
14. Lairet KF, Lairet JR, King BT, et al. Prehospital burn management
in a combat zone. Prehosp Emerg Care. 2012;16(2):273–276.
15. Lairet J, Bebarta VS, Maddry JK, et al. Prehospital interventions
performed in Afghanistan between November 2009 and March
2014. Mil Med. 2019;184(Suppl 1):133–137.

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