Page 120 - JSOM Spring 2025

trained medics and expeditious evacuation. Current practices Committee on Tactical Combat Casualty Care (CoTCCC)
by entities such as the DoD and North Atlantic Treaty Organi- Position Statement on Prolonged Casualty Care (PCC):
zation (NATO) are supported by evidence collected in counter- 01 May 2024
insurgency operations and other conflicts in which transport J Spec Oper Med. 2024;24(2):111–113.
times to care rarely went beyond one hour, and casualty rates doi:10.55460/RWAU-AVBM
and tactical situations rarely exceeded capabilities. Tourniquets Michael A. Remley, Dan Mosley, Sean Keenan,
cause complications when misused or utilized for prolonged Travis G. Deaton, Harold R. Montgomery, Russ S. Kotwal,
durations, and in near-peer or peer-peer conflicts, contested George A. Barbee, Lanny F. Littlejohn, Justin Wilson,
airspace and the impact of high-attrition warfare may increase Curtis Hall, Paul E. Loos, John B. Holcomb,
time to definitive care and limit training resources. We present Jennifer M. Gurney
a series of cases from the war in Ukraine that suggest tourni-
quet practices are contributing to complications such as limb Casualty Evacuation in Arctic and Extreme Cold
amputation, overall morbidity and mortality, and increased Environments: A Paradigm Shift for Traumatic Hypothermia
burden on the medical system. We discuss factors that contrib- Management in Tactical Combat Casualty Care
ute to this phenomenon and propose interventions for use in Int J Circumpolar Health. 2023;82(1):2196047.
current and future similar contexts, with the ultimate goal of doi:10.108/22423982.2023.2196047
reducing morbidity and mortality. Titus J. Rund
In Arctic or extreme cold environments of Alaska, trauma care
Hypothermia and the Global War on Terror: is complicated by large expanses of geography and lack of for-
18 Years of Minimal Progress ward-positioned resources. This paper presents four hypothet-
Mil Med. 2024;189(Suppl 3):190–195.
doi:10.1093/milmed/usae072 ical vignettes highlighting austere cold medical priorities: (1)
traumatic hypothermia management as part of Tactical Com-
Luke Pumiglia, James M. Williams, Beau J. Prey, bat Casualty Care (TCCC) is clinically and tactically import-
Andrew D. Francis, Daniel T. Lammers, Bobby Z. Zhang, ant and hypothermia needs to be reprioritized in the MARCH
Hannah M. Palmerton, Grace E. Pak, Jennifer M. Gurney, algorithm to MhARCH; (2) at present it is unknown which
Jason R. Bingham, John M. McClellan
TCCC recommended medical equipment/supplies will func-
Introduction: The association between hypothermia, coagu- tion as designed in the extreme cold; (3) ensuring advanced
lopathy, and acidosis in trauma is well described. Hypothermia resuscitative care measures are available serves as a temporal
mitigation starts in the prehospital setting; however, it is often bridge until casualties can receive damage control resuscita-
a secondary focus after other life-saving interventions. The de- tion (DCR); and (4) current systems for managing traumatic
ployed environment further compounds the problem due to hypothermia in TCCC and casualty evacuation (CASEVAC)
prolonged evacuation times in rotary wing aircraft, resource are insufficient. In conclusion, numerous assessments recog-
limitations, and competing priorities. This analysis evaluates nise the DoD’s current solutions for employing medical forces
hypothermia in combat casualties and the relationship to re- in Arctic operations are not optimally postured to save lives.
suscitation strategy with blood products. There should be a joint standard for fielding an arctic sup-
plement to current medical equipment sets. A new way of
Methods: Using the data from the Department of Defense Joint
Trauma Registry from 2003 to 2021, a retrospective analy- thinking in terms of an “ecosystem” approach of immediate
sis was conducted on adult trauma patients. Inclusion criteria casualty protection and movement in CASEVAC doctrine is
was arrival at the first military treatment facility (MTF) hypo- needed to optimise these “Golden Minutes.”
thermic (<95ºF). Study variables included: mortality, year, de-
mographics, battle vs non-battle injury, mechanism, theater of Limitations of Triage in Military Mass Casualty Response:
operation, vitals, and labs. Subgroup analysis was performed A Case Series
on severely injured (15 < ISS < 75) hypothermic trauma patients J Spec Oper Med. 2024;24(3):62–66.
resuscitated with whole blood (WB) vs only component therapy. doi:10.55460/0GO5-QW03
Stephen C. Rush, Michael J. Lauria, Erik Scott DeSoucy,
Results: Of the 69,364 patients included, 908 (1.3%) arrived Eric J. Koch, Jonathan J. Kamler, Michael A. Remley,
hypothermic; the vast majority of whom (N = 847, 93.3%) ar- Nate Alway, Fredrick Brodie, Andrew Foudrait,
rived mildly hypothermic (90-94.9°F). Overall mortality rate Paul Barendregt, Michael Atkins, Keary Miller,
was 14.8%. Rates of hypothermia varied by year from 0.7% Richard Hines, Matthew Champagne, Lorenzo Paladino,
in 2003 to 3.9% in 2014 (P <0.005). On subgroup analysis, Stacy A. Shackelford, Ethan A Miles, Joseph Obiajulu,
mortality rates were similar between patients resuscitated with Warren C. Dorlac, Jennifer M. Gurney, Douglas Robb,
WB vs only component therapy; though base deficit values Ricky C. Kue
were higher in the WB cohort (-10 vs -6, P < 0.001).
Introduction: Mass casualty events (MASCALs) in the combat
Conclusion: Despite nearly 20 years of combat operations, hy- environment, which involve large numbers of casualties that
pothermia continues to be a challenge in military trauma and overwhelm immediately available resources, are fundamen-
is associated with a high mortality rate. Mortality was similar tally chaotic and dynamic and inherently dangerous. Formal
between hypothermic trauma patients resuscitated with WB vs triage systems use diagnostic algorithms, colored markers, and
component therapy, despite greater physiologic derangements four or more named categories. We hypothesized that formal
on arrival in patients who received WB. As the military has the triage systems are inadequately trained and practiced and too
potential to conduct missions in environments where the risk complex to successfully implement in true MASCAL events.
of hypothermia is high, further research into hypothermia mit- This retrospective analysis evaluates the real-world applica-
igation techniques and resuscitation strategies in the deployed tion of triage systems in prehospital military MASCALs and
setting is warranted. other aspects of MASCAL management.

118 | JSOM Volume 25, Edition 1 / Spring 2025