Page 118 - JSOM Spring 2025

13% (276) had prehospital needle thoracostomies performed, Rethinking Limb Tourniquet Conversion in the
and 19% (416) had limb tourniquets placed. Most of the pa- Prehospital Environment
tients were male (97%), partner forces members or humanitar- J Trauma Acute Care Surg. 2023;95(6):e54–e60.
ian casualties (70%), and survived to discharge (87%). doi:10.1097/TA.0000000000004134
John B. Holcomb, Warren C. Dorlac, Brendon G. Drew,
Conclusions: Combat casualties with chest trauma often have Frank K. Butler, Jennifer M. Gurney, Harold R. Montgomery,
multiple injuries complicating prehospital and hospital care. Stacy A. Shackelford, Eric A. Bank, Jeff D. Kerby,
Explosions and gunshot wounds are common mechanisms of John F. Kragh, Michael A. Person, Jessica L. Patterson,
injury associated with the need for tube thoracostomy, and Olha Levchuk, Mykola Andriievskyi, Glib Bitiukov,
these interventions are often performed by enlisted medical Oleksandr Danyljuk, Oleksandr Linchevskyy
personnel. Future efforts should be made to provide a correla-
tion between chest interventions and pneumothorax manage- We have highlighted the issue of overuse of tourniquets and
ment in prehospital thoracic trauma. described why tourniquet conversion and replacement should
be taught and done in the prehospital setting.
Low-dose Ketamine for Acute Pain: A Narrative Review
Am J Emerg Med. 2024:86:41–55. Lessons Learned by the 75th Ranger Regiment during
doi:10.1016/j.ajem.2024.09.033 Twenty Years of Tactical Combat Casualty Care
Robert G. Fuller, Evan M. Kikla, Andrew P. W. Fawcett, Military Review. 2024:82–91.
John D. Hesling, Sean Keenan, Kathleen M. Flarity, Ryan M. Knight, Russ S. Kotwal, Charles H. Moore
Michael S. Patzkowski, Michael D. April, Vikhyat S. Bebarta,
Steven G. Schauer Preparing Future Military Medical Officers to Conduct
Emergency Fresh Whole Blood Transfusions in Austere
Introduction: Acute pain management is a critical component Environments: A Novel Training Curriculum
of prehospital and emergency medical care. Opioids are ef- Mil Med. 2024;189(9-10):e2192–e2199.
fective; however, the risks and side-effects of opioids have led doi:10.1093/milmed/usae162
providers to use low-dose ketamine (LDK) for safe and effec- Kevin J. Matthews, Samuel Walther, Zachery L. Brown,
tive treatment of acute pain. Joshua P. Cuestas, Jonathan T. Shumaker, Durwood W. Moore,
Rebekah Cole
Methods: We conducted a scoping narrative review to explore
the efficacy of LDK for the treatment of acute pain in the pre- Introduction: Providing resilient Damage Control Resuscita-
hospital setting and emergency department (ED) setting. The tion capabilities as close to the point of injury as possible is
prehospital review includes studies evaluating the use of LDK paramount to reducing mortality and improving patient out-
in both civilian and military settings. We utilized PubMed to comes for our nation’s warfighters. Emergency Fresh Whole
identify prospective and retrospective clinical studies related Blood Transfusions (EFWBT) play a critical role in support-
to this topic. We limited study inclusion to quality prospective ing this capability, especially in future large-scale combat op-
and retrospective clinical and observational studies published erations against peer adversaries with expected large patient
in the English language prior to January 30, 2024. We did not volumes, restrictive operating environments, and unreliable lo-
limit study inclusion based on patient population or mode of gistical supply lines. Although there are service-specific train-
administration. We utilized the PRISMA-ScR checklist to con- ing programs for whole blood transfusion, there is currently
duct this review. no dedicated EFWBT training for future military medical of-
ficers. To address this gap, we developed, implemented, and
Results: Using our methodology, we found 249 publications evaluated a training program to enhance EFWBT proficiency
responsive to our search strategy. Of these, 178 publications in third-year military medical students at the F. Edward Hebert
were clearly outside inclusion criteria based on abstract review. School of Medicine at the USU.
Seventy-one studies were sought for retrieval and more detailed
review. Of these, 22 records were excluded after review and Materials and methods: After reviewing both the 75th Ranger
43 met initial inclusion criteria. An additional 22 studies were Regiment Ranger O-Low Titer program and the Marine
found via snowballing. In total, 64 studies met inclusion crite- Corps’ Valkyrie program, along with the relevant Joint Trauma
ria for this analysis. 21 studies related to the treatment of acute System Clinical Practice Guidelines, we created a streamlined
pain in the prehospital setting, four of which were randomized and abbreviated training curriculum. The training consisted
clinical trials (RCTs). Forty-three studies evaluate the treatment of both online preparatory materials as well as a 2-hour in-
of acute pain in the ED. This included 28 RCTs. Taken together, person training that included didactic and experiential learn-
the studies suggest that LDK is non-inferior to opioids when ing components. Participants were 165 active duty third-year
used alone. When used as an adjunct to opioid therapy, LDK can medical students at USU. Participants were assessed using a
provide an opioid-sparing effect. Ketamine doses <0.5 mg/kg pre- and post-assessment self-reported questionnaire on their
were not associated with significant side effects. confidence in the practical application and administrative
oversight requirements of an EFWBT program. Participants’
Conclusions: LDK is a safe and effective option for acute pain
treatment. It can be used as an alternative therapy to opioids performance was also assessed using a pre/post knowledge
or used in conjunction with them to reduce opioid exposure assessment consisting of 10 multiple choice questions identi-
through its opioid-sparing effect. Importantly, LDK is avail- fied as critical to understanding of the academic principles of
able in a variety of formulations including intramuscular, in- EFWBT along with the baseline questionnaire.
travenous, and intranasal, making it an effective acute pain Results: Differences in the mean scores of the pre- and post-
treatment option in both the prehospital and ED settings. LDK assessment self-reported questionnaire (increased from 2.32
holds promise as an emergency treatment in the evolving land- to 3.95) were statistically significant (P < .001). Similarly,
scape of acute pain management. there was a statistically significant improvement in student

116 | JSOM Volume 25, Edition 1 / Spring 2025