Page 115 - JSOM Spring 2025

Tactical Combat Casualty Care & En Route Combat Casualty Care

Selected Abstracts from 2024

Harold R. Montgomery, ATP

he Committee on Tactical Combat Casualty Care assessment within the first 72-h after injury. We conducted
T(CoTCCC) is the branch of the Joint Trauma System (JTS) a retrospective cohort study of all casualties with intubation
focused on the standard of care for prehospital battlefield documented in the prehospital setting. We used descriptive and
medicine. The Committee on En Route Combat Casualty Care inferential statistical analysis to compare survivors through
(CoERCCC) is the branch of the JTS focused on the standard 7 days post injury versus non-survivors. We constructed 3
of care for en route care through the evacuation echelons of multi variable logistic regression models to test for associations
care. The JTS is the Department of Defense Center of Excel- between interventions and 7-day survival after adjusting for
lence for Trauma and division of the Defense Health Agency injury severity score, mechanism of injury, and receipt of seda-
(DHA) that provides clinical practice guidelines and perfor- tives, paralytics, and blood products.
mance improvement for all levels of military trauma care.
Results: There were 1377 of 48,301 patients with documen-
tation of prehospital intubation in a combat setting. Of these,
The CoTCCC and CoERCCC maintain a monthly journal
watch to maintain awareness of published medical evidence 1028 (75%) survived through 7 days post injury. Higher pro-
relevant to the ongoing review of TCCC and ERCCC Guide- portions of survivors received ketamine, paralytic agents, par-
lines, training, and practices. The committees conduct searches enteral opioids, and parenteral benzodiazepines; there was no
based on over 100 keywords and screen abstracts for current difference in the proportions of survivors versus non-survivors
change proposals or potential proposed changes for lead au- receiving etomidate. The multivariable models consistently
thors. In 2024, there were 2,190 abstracts found in searches of demonstrated positive associations between 7-day survival and
which 331 were identified to be included in the journal watch. receipt of non-depolarizing paralytics and opioid analgesics.
Below is a sampling of those relevant articles from the last Conclusions: We found an association between non- depolarizing
year. The leadership of the committees highly recommends paralytic and opioid receipt with 7-day survival among patients
these selected articles as highlighted reading for prehospital undergoing prehospital intubation. The literature would benefit
medical directors, unit medical officers, senior medics, and from future multi-center randomized controlled trials to estab-
combat casualty care instructors. lish optimal pharmacologic strategies for trauma patients un-
dergoing prehospital intubation.
Posting of articles does not imply agreement or disagreement
with the contents nor does it constitute a change in TCCC or A Scoping Review of Military Combat Casualty Data on
ERCCC guidelines, practices, or training. Submassive, Massive, and Supermassive Transfusions
Mil Med. 2025;190(1-2):e99–e106.
Interventions Associated with Survival After doi:10.1093/milmed/usae349
Prehospital Intubation in the Deployed Combat Setting Rohan C. Banerjee, Jasmine A. Castillejos, Sean P. Krewson,
Am J Emerg Med. 2024;79:79–84. Karen R. Mina, Andrew D. Fisher, Michael D. April,
doi:10.1016/j.ajem.2024.01.047 Steven G. Schauer
Michael D. April, Rachel E. Bridwell, William T. Davis,
Joshua J. Oliver, Brit Long, Andrew D. Fisher, Adit A. Ginde, Introduction: Blood transfusions are common during combat
Steven G. Schauer casualty care, aiming to address the loss of blood volume that
often accompanies severe battlefield injuries. This scoping re-
Introduction: Airway compromise is the second leading cause view delves into the existing military combat casualty data
of potentially preventable death on the battlefield. Prehos- to analyze the efficacy, challenges, and advances in the use of
pital airway management is often unavoidable in a kinetic massive and super-massive transfusions in the management of
combat environment and expected to increase in future wars critically injured warfighters.
where timely evacuation will be unreliable and air superiority Materials and methods: We performed a scoping review of
not guaranteed. We compared characteristics of survivors to combat-related literature published between 2006 and 2023
non-survivors among combat casualties undergoing prehospi- pertaining to massive transfusions used during combat deploy-
tal airway intubation.
ments. We utilized PubMed to identify relevant studies and
Materials and methods: We requested all Department of De- utilized the PRISMA-ScR Checklist to conduct the review.
fense Trauma Registry (DODTR) encounters during 2007–
2023 with documentation of any airway intervention or Results: We identified 53 studies that met the inclusion criteria
with the majority being retrospective studies from registries

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