Page 10 - JSOM Spring 2024

FEATURE ARTICLES colleagues describe their procedural performance checklist for
Occlusion Pressures of Tactical Pneumatic Tourniquet 2": bifemoral veno-venous extracorporeal membrane oxygenation
cannula placement, which they developed using a modified Del-
Wall and colleagues measured occlusion pressures of the tactical phi method that incorporated input from 30 experts. Designed
pneumatic tourniquet 2" (TPT2) on the forearms and thighs of 68 for advanced medical teams working in austere operational en-
subjects. Notably, arterial occlusion was not reached on all thighs, vironments, this 32-item checklist can be used to optimize team
and even when it was reached, the required pressures far exceeded performance and training through standardization.
those reported for 3.8cm-wide non-pneumatic tourniquets. The
authors conclude that while the TPT2 may be useful to the emer- Emergency Fresh Whole Blood Transfusion Training for Ukrain-
gency-use limb tourniquet certification system development pro- ian Health Professionals in Austere Environments: Brown
cess, they are not suitable for clinical use. and colleagues evaluate a training program aimed at enhancing
Life Over Limb: Why Not Both? Revisiting Tourniquet Prac- Ukrainian healthcare provider proficiency with emergency fresh
tices Based on Lessons Learned from the War in Ukraine: whole blood transfusion, based on the Joint Trauma System Clin-
ical Practice Guidelines, TCCC Guidelines, ROLO program, and
Patterson and colleagues present a series of cases from the war Marine Corps Valkyrie program. Eight Ukrainian healthcare pro-
in Ukraine that suggest tourniquet practices are contributing to fessionals completed the training, which resulted in significantly
overall morbidity and mortality and placing an increased burden increased confidence in their ability to conduct emergency fresh
on the medical system. Factors leading to these outcomes include whole blood transfusion on the battlefield and train others in the
prolonged evacuation times, rigid protocolization of concepts, and techniques. Furthermore, the average rate of improvement was
lack of standardization of training and availability of medics. To greater for these healthcare professionals than for a comparison
minimize complications associated with tourniquet use in this set- group of third-year medical students.
ting, the authors propose a renewed commitment to training the
full spectrum of TCCC concepts and revisiting the role of tourni-
quet practices in guidelines.
Ukrainian healthcare
professionals inspect
donor collection
equipment.
A resuscitation area in Ukraine, where Photo credit:
tourniquets are routinely washed and Tom Balfour
re-used for multiple patients.

Heat Tolerance Testing and the Return to Duty Decision: A
Two-Year Case Cohort Analysis: In a cohort of 43 Servicemem-
bers, Kester and colleagues analyzed the ability of heat tolerance
testing (HTT) to predict exertional heat illness recurrence and its
Development and Implementation of a Standard Operating utility as a diagnostic tool in exertional heat stroke. They found
Procedure for Military Working Dog Blood Collection, Stor- that HTT had a 100% negative predictive value for future exer-
age, and Transport: Evernham and colleagues detail the creation tional heat illness events over 2 years of follow-up for Service-
of a canine walking blood bank program in the Horn of Africa. members with a history of recurrent heat injury and negative HTT
They describe obstacles to implementation, including scarcity of results. The authors conclude that HTT should be considered as
veterinary-specific collection sets in the deployed environment and a tool to evaluate return to duty following exertional heat illness.
complexities related to transportation of collected units, commu- When Minutes Matter: A Comparison of Whole Blood Collec-
nication regarding the distribution of units, and development of a tion Techniques: In this study involving 86 military first respond-
tracking system for canine blood. Future advances in canine trans- ers and licensed medical providers, Wier and colleagues compared
fusion medicine can help to bridge the capability gap in medical the straight stick and ruggedized lock methods of whole blood
readiness for dogs, which leaves them vulnerable to death from collection. Based on several battlefield-relevant metrics, the au-
massive hemorrhage caused by battlefield injuries. thors conclude that straight stick is optimal when timely collection
is imperative, while the ruggedized lock may be preferable when
device stability or replacing the collection bag is a consideration.
These findings highlight the importance of studying blood collec-
tion techniques to make appropriate choices when attempting to
Collection of military working dog whole save the lives of traumatically wounded Soldiers.
blood unit.

Straight stick blood collection
technique. A gauze roll is
commonly used to maintain
Derivation of a Procedural Performance Checklist for Bifem- the position of the needle.
oral Veno-Venous Extracorporeal Membrane Oxygenation
Cannula Placement in Operational Environments: Powell and

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