Page 11 - JSOM Summer 2024

performance in two groups of Servicemembers (N=99). The re- Needle Decompression Complicated by Cardiac Injury in a
searchers found that this this offering engaged participants in Prehospital Environment: Davis and colleagues present the case
health and human performance optimization practices to achieve of an adult male who presented to the emergency department after
a goal of prevention of physical or mental injury. sustaining multiple stab wounds during an altercation. On arrival,
the patient had a 14-gauge angiocatheter inserted by a mid-level
Incidence of Coagulopathy After Resuscitation at a Role 1 Fa- provider at the 4th intercostal space, left of the parasternal line, tra-
cility: The Prehospital Trauma Registry Experience: Inman and versing the right ventricle and interventricular septum, and termi-
colleagues describe the DoDTR experience with coagulopathy af- nating in the left ventricle. This case emphasizes the importance of
ter resuscitation using two cohorts (the baseline non-coagulopathic understanding the landmarks of performing needle decompression
group, n=383 and the coagulopathic cohort, n=212). The authors in increasing the procedure’s efficacy and reducing the risk of injury.
found that about one-third of wounded patients had laboratory
evidence of coagulopathy upon presentation to a forward medical Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in
care facility, suggesting that, in addition to the need for shelf-stable a Special Operations Soldier: A Case Report: Osborne and
blood products for management of acute traumatic coagulopathy, colleagues discuss the case of a 43-year-old Special Operator who
further studies are needed to ensure that advanced diagnostic tools presented to his medics during selection physical assessment test-
and capabilities are available to facilitate early diagnosis. ing with palpitations and lightheadedness. Subsequent workup re-
vealed arrhythmogenic right ventricular cardiomyopathy (ARVC).
Management of this progressive, hereditary condition includes
1,357 casualties activity modification, class III antiarrhythmic medications, and
possible placement of an implantable cardioverter defibrillator to
648 casualties not prevent sudden cardiac death.
linkable to DoDTR
Flow diagram.
709 casualties DoDTR = Department of EDITORIAL
linkable to DoDTR
Defense Trauma Registry; Adoption of the CH-47 to MEDEVAC Special Operations
INR = international
114 casualties Forces in USAFRICOM: Leone and colleagues argue that the
without INR or normalized ratio. U.S. military should augment its regional medical evacuation
platelets
(MEDEVAC) platform in USAFRICOM with CH-47 Chinooks,
as these craft can improve medical capabilities in austere environ-
595 casualties
included in analysis ments far from definitive care facilities. The CH-47’s larger fuse-
lage, higher maximum gross weight, and faster cruising speed have
contributed to decreased mortality in prior use cases. Its adoption
The Effect of Critical Task Auto-failure Criteria on Medical could address gaps in prolonged field care to complement the ca-
Evaluation Methods in the Pararescue Schoolhouse: In the pabilities of the UH-60M Blackhawk.
context of pararescue training evaluation, Richardson and col-
leagues compared the use of the traditional checklist (TC) with ONGOING SERIES
an alternative weighted checklist (AWC), which allows up to two LAW ENFORCEMENT & TACTICAL MEDICINE
minor errors, with critical task errors resulting in auto-failure. The Audit and Inventory of Federal Law Enforcement Agency Tac-
authors found that the AWC method strongly emphasizes critical tical Medic Bags: Knapp and Tang report on an audit conducted
tasks without significantly increasing failures and may provide ad- by the Bureau of Alcohol, Tobacco, Firearms and Explosives of
ditional benefits by being more closely aligned with training objec- 66 agency-issued tactical medic bags. Bag contents demonstrated
tives, while providing quantifiable data for a longitudinal review a high degree of completeness, suggesting overall programmatic
of student performance. mission readiness, especially with regards to interventions likely
to be required for severe traumatic injuries.
CASE REPORTS
Lumbar Paraspinal Compartment Syndrome in an Active-Duty PROLONGED CASUALTY CARE
Army Special Operations Aviation Soldier: Wagner and col- Maritime Applications of Prolonged Casualty Care: Sepsis on
leagues describe the case of a 27-year-old, male, active-duty, Spe- a Destroyer During Distributed Maritime Operations: Tad-
cial Operations Aviation Soldier who presented to the emergency lock and colleagues present an innovative approach to teaching
department and was found to have lumbar paraspinal muscle complex operational medicine concepts (including Prolonged Ca-
compartment syndrome—a rare but serious condition that should sualty Care) to austere Role 1 maritime caregivers using a hypo-
be considered among military personnel when evaluating back thetical scenario involving a patient with sepsis and septic shock.
pain refractory to initial treatment.
UNCONVENTIONAL RESILIENCE
Social Determinant of Unconventional Resilience: Tactical
Engagement with Impression Management: Building on their
operational model, Jeschke and colleagues demonstrate that im-
pression management allows Special Operation Forces medics to
navigate implicit social status symbols to either degrade or opti-
Sagittal T1 magnetic resonance mize performance. To support their argument, the authors pro-
imaging from T10-S1 demonstrating vide background information on impression management and
hypoenhancement of the paraspinal perceived competency; use qualitative and qualitative data to de-
musculature, prominent between L3 fine and thematize various types of impression management; and
and S1. relate tactical engagement with impression through the metaphor
of bag sets.
TCCC UPDATES
Committee on Tactical Combat Casualty Care (CoTCCC) Position
Statement on Prolonged Casualty Care (PCC) 01 May 2024

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