Page 119 - JSOM Spring 2025

test scores, with the mean score increasing by approximately Introduction: Calcium derangements remain poorly character-
3 points or 30%. There was no significant difference in stu- ized in the combat trauma population. We describe the inci-
dent confidence assessment or test scores based on branch of dence of emergency department (ED) calcium derangements,
service. Students who had previously deployed did not show associated physiologic derangements, and 24-hour mortality
a statistically significant difference in scores compared to stu- from the deployed combat setting.
dents who had not previously deployed.
Materials and methods: We analyzed adult casualties from
Conclusions: Our results suggest that the implementation of 2007 to 2023 from the DoD Trauma Registry for U.S. mili-
streamlined EFWBT training into the undergraduate medical tary, U.S. contractor, and coalition casualties that had at least
education of future military medical officers offers an efficient 1 ionized calcium value documented in the ED at a Role 2 or
way to improve their baseline proficiency in EFWBTs. Future Role 3 military treatment facility. We constructed a series of
research is needed to assess the impact of this training on re- multivariable logistic regression models to test for the associ-
al-world applications in forward-deployed environments. ation of hypocalcemia and hypercalcemia with physiological
derangements, blood product consumption, and survival. Vital
A Review of 75th Ranger Regiment Battle-Injured Fatalities signs and other laboratory studies were based on the concur-
Incurred During Combat Operations From 2001 to 2021 rent ED encounter.
Mil Med. 2024;189(7-8):1728–1737. Results: There were 941 casualties that met inclusion for this
doi:10.1093/milmed/usad331 analysis with 26% (245) having at least 1 calcium derange-
Charles H. Moore, Russ S. Kotwal, Jeffrey T. Howard, ment. Among those, 22% (211) had at least 1 episode of hypo-
Montane B. Silverman, Jennifer M. Gurney, Andrew J. Rohrer, calcemia and 5% (43) had at least 1 episode of hypercalcemia
Ryan M. Knight
in the ED. The vast majority (97%, 917) received calcium
Introduction: The 75th Ranger Regiment is an elite U.S. mil- at least once. Median composite injury severity scores were
itary special operations unit that conducted over 20 years of lower among those with no calcium derangement (8 versus 17,
sustained combat operations. The Regiment has a history of P < .001). Survival was higher during the total hospitalization
providing novel and cutting-edge prehospital trauma care, (98% versus 93%) among those with calcium derangements
advancing and translating medical initiatives, and document- but similar at 24 hours (99% versus 98%, P = .059). After ad-
ing and reporting casualty care performance improvement justing for confounder, any hypocalcemic measurement was as-
efforts. sociated with an elevated international normalized ratio (odds
ratio 1.94, 95% CI 1.19-3.16), acidosis (1.66, 1.17–2.37),
Materials and methods: A retrospective case fatality rate tachycardia (2.11, 1.42–3.15), hypotension (1.92, 1.09–3.38),
(CFR) review, mortality review, and descriptive analysis of fa- depressed Glasgow coma scale (3.20, 2.13–4.81), elevated
talities were conducted for battle-injured personnel assigned shock index (2.19, 1.45–3.31), submassive transfusion (3.97,
or attached to the 75th Ranger Regiment from 2001 to 2021 2.60–6.05), massive transfusion (4.22, 2.66–6.70), supermas-
during combat operations primarily in Afghanistan and Iraq. sive transfusion (3.65, 2.07–6.43), and all hospital stay mor-
Fatalities were evaluated for population characteristics, cause tality (2.30, 1.00–5.29). Comparatively, any hypercalcemic
of death, mechanism of death, injury severity, injury surviv- measurement was associated with acidosis (2.96, 1.39–6.32),
ability, and death preventability.
depressed Glasgow coma scale (4.28, 1.81–10.13), submassive
Results: A total of 813 battle injury casualties, including 62 transfusion (3.40, 1.37-8.43), massive transfusion (6.25, 2.63–
fatalities, were incurred over 20 years and 1 month of contin- 14.83), and supermassive transfusion (13.00, 5.47–30.85).
uous combat operations. The Regiment maintained a zero rate
of prehospital preventable combat death. Additionally, no fa- Conclusions: Both hypocalcemia and hypercalcemia in the ED
talities had a mechanism of death because of isolated extrem- were associated with physiological derangements and blood
ity hemorrhage, tension pneumothorax, or airway obstruction. product use, with a greater extent observed in those with hy-
When comparing the CFR of the Regiment to the U.S. mili- pocalcemia compared to those with hypercalcemia. Prospec-
tary population as a whole, the Regiment had a significantly tive studies are underway to better explain and validate these
greater reduction in the cumulative CFR as measured by the findings.
difference in average annual percentage change.
Life Over Limb: Why Not Both? Revisiting Tourniquet
Conclusions: Documentation and analysis of casualties and Practices Based on Lessons Learned from the War
care, mortality and casualty reviews, and other performance in Ukraine
improvement efforts can guide combatant commanders, medi- J Spec Oper Med. Published online March 13, 2024.
cal directors, and fighting forces to reduce preventable combat doi:10.55460/V057-2PCH
deaths and the CFR. Early hemorrhage control, blood product Jessica L. Patterson, Robert T. Bryan, Michael Turconi,
resuscitation, and other lifesaving interventions should be es- Andrea Leiner, Timothy P. Plackett, Lori L. Rhodes,
tablished and maintained as a standard prehospital practice to Luke Sciulli, Stephen Donnelly, Christopher W. Reynolds,
mitigate fatalities with potentially survivable injuries. Joseph Leanza, Andrew D. Fisher, Taras Kushnir,
Valerii Artemenko, Kevin R. Ward, John B. Holcomb,
The Association of Calcium Derangements With 24-Hour Florian F. Schmitzberger
Outcomes in the Deployed Combat Setting The use of tourniquets for life-threatening limb hemorrhage
Mil Med. 2025;190(3-4):e498–e503. is standard of care in military and civilian medicine. The
doi:10.1093/milmed/usae364 United States (U.S.) Department of Defense (DoD) Commit-
Matthew M. Nguyen, Melissa L. Givens, Andrew D. Fisher, tee on Tactical Combat Casualty Care (CoTCCC) guidelines,
Julie A. Rizzo, Ricky M Ditzel Jr., Maxwell A. Braverman, as part of the Joint Trauma System, support the application
Michael D. April, Steven G. Schauer
of tourniquets within a structured system reliant on highly

TCCC Abstracts | 117