Page 9 - JSOM Fall 2023

they enable the rapid transfusions essential for the manage- the social domain within the Total Force Fitness (TFF) frame-
ment of massive hemorrhage—the most common cause of pre- work to include impact of the social group and environment
ventable battlefield death. on the individual. The authors examine knowledge gaps in
the current understanding and their associated challenges and
Pain Control and Point-of-Care Ultrasound: An Approach to review social fitness interventions. Finally, the research team
Rib Fractures for the Austere Provider: Snyder and Brillhart
describe the diagnosis and treatment of a rib fracture in a pa- offers recommendations for improvement in the areas of defin-
tient presenting with unlocalized flank and back pain. The ing and integrating the concept of social fitness in the military
approach detailed in this report can be useful for providers context and in initiative development for Servicemembers.
working in austere environments or facilities without access to PROLONGED CASUALTY CARE
advanced imaging technology.
Mobility Solutions After a Lower Extremity Fracture and Ap-
plicability to Battlefield and Wilderness Medicine: Childers
and colleagues analyzed the literature on fracture treatment
solutions for prolonged use in austere environments and to
enable patient mobilization. The available literature supports
the use of box, pneumatic, and traction splints; however none
of these techniques allow for ambulation. The authors sug-
Chest radiograph gest that complementary weight-bearing features may improve
demonstrating initially mobility and that biomaterial interventions to both internally
read as normal.
stabilize a fracture and allow for antibacterial materials to be
delivered to the injury site can maximize such features.
Common splints.
Three common
prehospital splinting
techniques include:
(A) a traction splint
that pulls the fractured
Altered Sympathoadrenal Activity: Following Cold-Water limb distally; (B) a
Diving: Kelly and colleagues observed the effects of two daily simple “box splint,”
bouts of cold-water diving on the hormonal and metabolic that stabilizes the
profiles of 5 elite Norwegian Special Forces members. The re- fracture with a rigid
searchers found evidence that these participants experienced support around three sides; and (C) a vacuum splint that encloses and
molds thousands of small balls around an injured extremity and can
rapid sympathetic-adreno-medullary (SAM/SNS) responses provide rigid support after deflation.
to cold-water diving and suppression of the hypothalamic-
pituitary-adrenal (HPA) axis and hormones related to repair BOOK REVIEW
and recovery. Larger studies are needed to fully characterize
the biological responses and adaptations that occur in extreme
exposures, such as cold-water submersion.
Black Hawk Down:
CASE REPORT A Story of Modern War
Phosphorus Burn Management with Multimodal Analge-
sia: Saint-Jean and colleagues report on the case of a patient
with burns to the hands from contact with white phosphorus.
Multi modal analgesia with lidocaine and intranasal ketamine
was used to treat and manage the patient. A similar regimen TECC FOR TEMS UPDATES
can be used in austere environments, including the battlefield,
where providers may encounter burns from weapons contain- Proceedings of the 2023 Spring/Summer Meeting of the
ing this chemical. Committee for Tactical Emergency Casualty Care (C-TECC)
and Committee Updates: The 2023 Spring/Summer C-TECC
Full Committee Meeting was held in conjunction with the
Special Operations Medical Association Scientific Assembly
(SOMSA) on May 15, 2023 in Raleigh, North Carolina. The
Healing on day meeting was robustly attended and included participation by
21 following leaders, subject matter experts, presenters, and stakeholders
treatment with from domestic and international law enforcement agencies,
multimodal emergency medical services (EMS), fire/rescue personnel, mili-
analgesia.
tary, industrial, and other interested parties.
TCCC UPDATES
CoTCCC Chairmanship Change and Upcoming Guideline
ONGOING SERIES Revision: The Committee on Tactical Combat Casualty Care
HUMAN PERFORMANCE OPTIMIZATION (CoTCCC) met in San Antonio on 06-07 September 2023.
Social Fitness and the Social Domain: A Holistic Approach This meeting was a final review of upcoming change proposals
Based on Total Force Fitness: McCarthy and colleagues analyze for airway management and traumatic brain injury portions of
various forms of social fitness to broaden the understanding of the TCCC Guidelines.

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