Page 121 - JSOM Spring 2025

Methods: We surveyed Special Operations Forces (SOF) med- Needlessly Treated: Evaluation of Prehospital Needle
ics known to us who have participated in military prehospital Thoracostomy
MASCALs and analyzed them. Aggregated data describing the J Trauma Nurs. 2024;31(5):242–248.
scope of the incidents, the use of formal triage algorithms and doi:10.1097/JTN.0000000000000808
colored markers, the number of categories, and the interven- Gabriel E. Vazquez, John R. Calhoun, Elizabeth A. Fuchsen,
tions on scene were analyzed using descriptive statistics, and Jeannette M. Capella, Cory C. Vaudt, Richard A. Sidwell,
lessons learned were consolidated. Hayden L. Smith, Carlos A. Pelaez
Results: From 1996 to 2022 we identified 29 MASCALs that Background: Needle thoracostomy is a potentially life-saving
were managed by military medics in the prehospital setting. intervention for tension pneumothorax but may be overused,
There was a median of three providers (range 1-85) and 15 potentially leading to unnecessary morbidity.
casualties (range 6-519) per event. Four or more formal tri-
age categories were used in only one event. Colored markers Objective: To review prehospital needle thoracostomy indica-
and formal algorithms were not used. Life-saving interven- tions, effectiveness, and adverse outcomes.
tions were performed in 27 of 29 (93%) missions and blood Methods: A retrospective cohort study was conducted based
transfusions were performed in four (17%) MASCALs. The on registry data for a United States Midwestern Level I trauma
top lessons learned were: 1) security and accountability are center for a 7.5-year period (January 2015 to May 2022).
cornerstones of MASCAL management; 2) casualty movement Included were patients who received prehospital needle tho-
is a priority; 3) intuitive triage categories are the default; 4) racostomy and trauma activation before hospital arrival. The
life-saving interventions are performed as time and tactics primary outcomes were correct indications and improvement
permit. in vital signs. Secondary outcomes were the need for chest
tubes, correct needle placement, complications, and survival.
Conclusion: Formal triage systems requiring the use of diag-
nostic algorithms, colored tags, and four or five categories Results: A total of n = 67 patients were reviewed, of which
are seldom implemented in real-world military prehospital n = 63 (94%) received a prehospital thoracostomy. Of the 63
MASCAL management. The training of field triage should be prehospital thoracostomies, 54 (86%) survived to arrival. Of
simplified and pragmatic, as exemplified by these instances. these 54, 44 (n = 81%) had documented reduced/absent breath
sounds, 15 (28%) hypotension, and 19 (35%) with difficulty
Maritime Applications of Prolonged Casualty Care: breathing/ventilating. Only four patients met all three pre-
A Series Introduction hospital trauma life support criteria: hypotension, difficulty
J Spec Oper Med. Published online March 13, 2024. ventilating, and absent breath sounds. There were no signif-
doi:10.55460/GOPF-AS1O icant changes in prehospital vitals before and after receiving
Matthew D. Tadlock, Levi K. Kitchen, Jermy J. Brower, needle thoracostomy. In patients receiving imaging (n = 54),
Michael S. Tripp there was evidence of 15 (28%) lung lacerations, 6 (11%) of
which had a pneumothorax and 3 (5%) near misses of import-
The current United States Navy and North Atlantic Treaty
Organization (NATO) maritime strategy is coalescing around ant structures. Review of needle catheters visible on computer
the concept of Distributed Maritime Operations (DMOs) to tomography imaging found 11 outside the chest and 1 in the
prepare for future large-scale combat operations with peer or abdominal cavity.
near-peer competitors. As a result, individual components of Conclusion: The study presents evidence of potential needle
naval forces will be more geographically dispersed and oper- thoracostomy overuse and morbidity. Adherence to specific
ating at a significant time and distance from higher levels of guidelines for needle decompression is needed.
medical care. We developed a series of educational scenarios
informed by real-world events to enhance the ability of Role PMID: 40081344; DOI: 10.55460/6208-YG5D
1 medical caregivers to apply the principles of Prolonged Ca-
sualty Care during current routine, crisis, and contingency
DMOs.

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