Page 97 - JSOM Fall 2024

Discussion and Conclusion: Understanding the impact of ex- Conclusion: Preliminary data from this arctic immersion
treme cold environments on the performance of life-saving CBRN simulation suggests that current CBRN protocols re-
techniques is critical to the success of potential arctic opera- quire increased time to completion and that material dysfunc-
tions. Preliminary data from this study demonstrate the signif- tion is common in arctic temperatures. Final data from these
icant impact the cold environment has on the performance of trials should inform the revision of current CPGs.
LSIs. Future analysis will include linear regression and further
analysis into the failure of medical equipment in extreme cold. Detection of Progressive Venom-Induced Consumption
This trial has demonstrated the feasibility and utility of future Coagulopathy (VICC) by Thromboelastography (TEG) in a
work at the National Science Foundation laboratory focused Severe Rabbit Model of Crotalid Envenomation
on human performance in extreme cold.
Phylicia Irons, LT, MC USN , Chris Treager, LCDR, MC
1,2
USN 1,2,3 , David Spivey, LT, MC USN , Fernando Gonzalez,
1,2
Assessing Performance of Chemical Exposure Management LT, MC USN , Sean Stuart, CDR, MC USN , Tyler Lopachin,
1,2
2,4
in the Arctic Environment using the Cryosphere Austere LT, MC USN , Lorie Gower , Diana Sheldon , Dr. Emily
2,6
2,5
2,6
Medicine Platform (CAMP)
Friedrich , Brittany Lassiter 2,6
2
Anderson AL , Bebarta VS , Giesbrecht G , Keenan S , Ritter, 1 Department of Emergency Medicine, NMRTC-Portsmouth,
1
2
1
1
AC , Getz T , Eisenhauer IF , Eazor J , Comart C , Vallin T , Portsmouth, VA
1
1
1
1
1
1
Lemery J 1 2 Combat Trauma Research Group, NMRTC-Portsmouth,
1 Department of Emergency Medicine, University of Colo- Portsmouth, VA
rado School of Medicine, Aurora, CO, USA 3 Bravo Surgical Company, 2d Medical Battalion, 2d MLG,
2 University of Manitoba, Winnipeg, MB, Canada Portsmouth, VA
4 Joint Task Force-Civil Support, Fort Eustis, VA
Introduction: The Department of Defense has identified read- 5 3d Medical Battalion, 3d MLG, Okinawa, Japan
iness for future warfare in the circumpolar north as strategic 6 General Dynamics Information Technology, Falls Church,
initiative. Operations in extreme cold temperatures require spe- VA
cific modifications to accommodate and optimize human per-
formance and to ensure medical device functionality in the event Introduction: About 8,000 venomous snake bites occur in the
of chemical, biologic, radiologic, and nuclear (CBRN) threats. United States yearly, 95% from pit vipers. Mortality occurs
Rendering medical care requires cognitive and manual dexter- from venom-induced consumption coagulopathy (VICC).
ity, yet a paucity of literature exists on human performance, Crotalidae polyvalent immune Fab (CroFab) treats envenom-
material performance, and the effectiveness of current military ation, but supply is limited and costly. Evaluation of VICC by
clinical practice guidelines. In this study we assess performance thromboelastography (TEG) has been successfully tested by
of Tactical Combat Casualty Care (TCCC) CBRN initial man- our group during in vitro simulated pit viper envenomation.
agement guidelines in an extreme cold (–24ºC) environment to This study compares TEG and conventional testing in the de-
identify human and material performance limitations of current tection and reversal of VICC after CroFab administration.
approaches to CBRN care under these conditions.
Methods: An IACUC-approved protocol using Oryctolagus
Methods: Thirty emergency medical services (EMS) med- cuniculus was used in this two-phase study. Phase 1 determined
ics performed TCCC CBRN clinical practice guideline (CPG the lethal dose (LD50) of intravenous (IV) Crotalus atrox
ID:69) tasks in the National Ice Core Facility in room tem- venom required for VICC using 3 groups, obtaining blood,
perature (20ºC) and extreme cold (–24ºC) environments. Thir- and performing the analysis with TEG and conventional coag-
ty-minute acclimatization preceded simulated performance of ulation markers. Phase 2 utilized 3 arms: untreated, medium,
11 life-saving interventions (LSIs) while maintaining chemical and max dose CroFab. Each arm received the calculated LD50
exposure precautions. LSIs were timed and observed for ef- IV venom followed by CroFab. After CroFab, blood was col-
ficacy and equipment malfunction. Neuropsychological and lected to monitor coagulopathy. For comparison, values were
cognitive testing was performed before and after each period converted to a unitless value based on reference ranges.
of simulation.
Results: In Phase 1, PT showed a difference between dose
Results: Preliminary results from 6 participants who com- groups at T+10min after envenomation. In contrast, R time
pleted both simulation periods demonstrated longer time showed differences at T+1min with more prolonged R time
to completion of CBRN tasks at extreme cold versus room in higher doses. Thrombocytopenia was demonstrated at
temperature (35.8 vs. 26.9min, P<.05, 95% CI for difference T+1min, while MA did not show a difference until T+10min.
5.3–12.5min). Individual tasks most affected by the cold envi- In Phase 2, when comparing PT and R time between the dose
ronment included donning of mission oriented protective pos- groups, TEG showed higher sensitivity in the early detection
ture (MOPP) gear, cricothyroidotomy, peripheral intravenous of the reversal of VICC. Thrombocytopenia was more pro-
access, and CYANOKIT deployment. nounced in the untreated arm with a significant difference at
T+10min, whereas the MA did not show sensitivity toward the
Discussion: Preliminarily, this study demonstrated delayed
time to deployment of current CBRN CPGs in an arctic envi- detection of reversal. With CroFab, the α-angle did not show
ronment and identified lessons learned from MOPP gear us- differences between groups until T+180min and did not reach
age in the extreme cold. We identified equipment malfunction a significant difference, while fibrinogen showed no difference
and medic performance limitations of arctic temperatures. We overall and there was no difference between the two.
promise future data on the remaining participants and on hu- Discussion: In our model, certain TEG markers detected en-
man and neurocognitive performance, which should inform venomation faster than standard methods. We found that TEG
CPG revision and future research to improve approaches to markers can detect correction of VICC after CroFab sooner
prehospital field care. than traditional markers. Overall, these findings suggest TEG
2024 SOMSA Abstracts | 95