Page 11 - JSOM Spring 2024

Prescreened Whole O Blood Group Walking Blood Bank a scale of 10. Though limited, these finding can serve as proof-of-
Capabilities for Nontraditional Maritime Medical Receiving concept that methoxyflurane use in deployed combat shows both
Platforms: A Case Series: In this case series spanning 6 months, feasibility and usability for analgesia.
Chang and colleagues describe three walking blood bank (WBB) Management of Rib Fractures in the Combat Environment:
experiences of an expeditionary resuscitative surgical system team, As body armor improves, survival from ever-larger blasts becomes
attached to three nontraditional maritime medical receiving plat- possible, resulting in more rib fractures. Smith and colleagues pro-
forms. They found significant variations in the number of screened pose a simple and thoughtful rib fracture treatment algorithm that
eligible donors, the number of low-titer group O whole blood may reduce the morbidity and mortality of rib fractures in the
donors, and the timely arrival at WBB activation sites between combat environment.
the platforms. The authors therefore recommend that capability
development, education, and training focus on optimizing the per-
formance of low-titer group O whole blood WBB on maritime ONGOING SERIES
platforms with limited blood storage or screening capabilities. PROLONGED CASUALTY CARE
Maritime Applications of Prolonged Casualty Care: A Series
The Use of Tourniquets in the Russo-Ukrainian War: Using Introduction: Tadlock and colleagues introduce a forthcoming
tourniquet data from military hospital facilities in Ukraine from series of educational scenarios based on real events. The scenarios
2014 to 2022 (N=2,496), Samarskyi and colleagues evaluated aim to enhance the ability of Role 1 medical caregivers to apply
the type, number, and duration of tourniquets per limb, the clin- the principles of Prolonged Casualty Care during current routine,
ical course of limb injuries, and the functional status of the in- crisis, and contingency Distributed Maritime Operations and will
jured limbs during the 24 hours post-injury. Their key findings address the following clinical conditions: sepsis/septic shock, burn
were that prompt triage and evacuation of injured combatants can injury, drowning, acute and delayed presentations of traumatic
save affected limbs, even when tourniquet use exceeds 2 hours brain injury, blunt abdominal trauma with hypotension, lower-
and that tourniquet syndrome can be prevented using a hemo- extremity crush injury, and acute pulmonary embolism.
static tourniquet.
Water Decontamination Products for Wound Irrigation in UNCONVENTIONAL RESILIENCE
Austere Environments: Benchtop Evaluation and Recom- Social Determinant of Unconventional Resilience: Tactical En-
mendations: Holcomb and colleagues studied the long-term anti- gagement with Bonding Patterns: Building on their operational
microbial effectiveness of military purification powder compared model, Jeschke and colleagues describe how bonding patterns es-
with 6 currently available civilian decontamination methods. Each tablish intra- and interpersonal connections that allow dynamic
method was evaluated using five different water sources (pond freedom of maneuver to take place in ambiguity. Through qualita-
water, river water, inoculated saline, tap water, and sterile saline). tive data, the authors illustrate the various ways medics on Special
Although all methods decreased bacterial counts below the limit Operations Surgical Teams relate to themselves, others, and the
of detection, they had variable effects on the pH and turbidity of Special Operations Forces culture. The authors also highlight the
the water samples and ranged widely in price and water through- importance of bonding patterns in orienting these medics’ pro-
put. The authors conclude that size, cost, and production capa- prioception and kinesthesia in the performance space.
bility of decontamination methods should be evaluated for the
intended application in austere settings. THE WORLD OF SPECIAL OPERATIONS MEDICINE
Special Operations and Space Medicine for a Joint Future:
In this commentary, Hetzler and colleagues advocate for closer
collaboration between the medical communities of special op-
erations and space. They describe similarities in both the opera-
tional context and in medical care in their respective domains. The
authors argue that identifying and appreciating similarities and
understanding history, key actors, and authorities to analyze and
realize opportunities will enable both parties to find synergy for
the development of like efforts and goals.

pH of saline/water before (black bar) and after chemical purification Special Operations Forces
(blue bars) or filtration/ultraviolet purification (red bars). in space.
Photo by COL Drew Morgan
Sterile Instrument Storage in an Austere Environment: Are during Expedition 60, 61, and
Sterile Peel Packaging and Cellulose Wrapping Equivalent? 62 to the International pace
Lanham and colleagues compared sterile peel packaging and ster- Station on behalf of NASA.
ile cellulose wrapping for sterile instrument storage in an austere
environment characterized by elevated temperature and humidity.
They used stainless steel screws to represent small, lightweight,
low-profile surgical instruments. The time-zero control and ster-
ile cellulose wrapping groups showed no growth, but after 6 and
12 weeks, the sterile peel packaging and control groups showed BOOK REVIEW
growth, demonstrating that sterile peel packaging was not equiv- Tell Them Yourself: It’s Not Your Day
alent to sterile cellulose wrapping in this type of austere environ- to Die
ment. The most common culture isolates were gram-positive rods
and two common nosocomial Staphylococcus species.
Deployed Combat Use of Methoxyflurane for Analgesia:
Schauer and colleagues describe methoxyflurane use reported in
the Department of Defense Trauma Registry from 2007 to 2023. TCCC UPDATES
Of 22 cases of methoxyflurane use, only 3 casualties had multiple Tactical Combat Casualty Care (TCCC) Guidelines, 25 January
pain scores measured, with a median pain score change of –3 on 2024

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