Page 22 - JSOM Summer 2024

an MDO/LSCO, the ability to evacuate patients rapidly will be thoracostomy. Future efforts should be made to provide cor-
compromised. More adaptable and mobile battalion aid sta- relation between chest interventions and pneumothorax man-
tions with physician assistants and physicians will likely be in agement in prehospital thoracic trauma.
a more forward posture, near the forward line of troops and
provide care to casualties as they are evacuated from the POI. Acknowledgments
SOF enlisted medical personnel will also likely be required to The authors acknowledge the Department of Defense Trauma
provide a higher level of care for longer periods. Conversely, Registry (DoDTR) for providing the data for this study.
there is a much higher likelihood that SOF will be conducting
missions in coordination with conventional forces, so the care Author Contributions
of SOF casualties may be performed by conventional medics ADF conceptualized the study and drafted the initial manu-
and vice-versa. SOF medics may be required to instruct and script. JJ, MDA, JL, XSA, and JCM provided key subject mat-
supervise conventional medics/corpsmen performing more in- ter expertise and critical revisions to the manuscript. SGS is
vasive procedures. Furthermore, SOF medics tend to perform the overall principal investigator for the dataset from which
more interventions in combat casualties and are likely to be this was derived and performed the data analysis. All authors
more comfortable with these interventions. 22 contributed substantially. ADF accepts overall responsibility
for the manuscript.
It is expected that the number of casualties in future LSCOs
will grossly exceed available medical personnel. Medical pro- Disclosures
viders of all levels of training will need to be proficient with The authors have nothing to disclose.
tube thoracostomy and other procedures. This may require a
change to the logistics and training currently offered to Role 1 Funding
personnel, including the Medical Enhancement Sets. Perform- SGS, ADF, and MDA have received funding from the Depart-
ing tube thoracostomy is a skill for medical providers and not ment of Defense in the form of grants to his institution for
a skill that should be performed by medics at the POI. Per- unrelated efforts. We have no other conflicts to report.
forming a finger thoracostomy is a skill with which medics
should be familiar and proficient. 23 Disclaimer
The views expressed in this article are those of the authors and
There are no specific U.S. military prehospital guidelines for do not reflect the official policy or position of the US Army
treatment of hemothorax. Needle thoracostomy does not Medical Department, Department of the Army, Department of
address it. However, Ivey et al. found that 30% of thoracic Defense, or the U.S. Government.
trauma casualties had a hemothorax. The TCCC guidelines
6
recommend simple thoracostomy or chest tube for casualties References
4
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provide insight into current casualties that may require a tube milmed-d-11-00422

20 | JSOM Volume 24, Edition 2 / Summer 2024