Page 63 - JSOM Spring 2025

Methods hospital, there was a lack of coordination and communication
between the transporting and receiving teams. Standardization
We gathered four combat medical cases documenting mis- of the handoff process, use of standard terms, and consistent
communication that impacted the medical care or the mis- processes for prior coordination could mitigate the effect of
sion. Information obtained included the setting, environment, miscommunication in such cases.
presence of enemy threat, diagnosis, details of the miscommu-
nication, and outcomes. Information related to operational se- Case 2
curity or personally identifiable information was omitted. A combat search and rescue (CSAR) team comprised of 6 PJs
aboard two HH60 helicopters was called for extrication and
Results evacuation of multiple casualties after an improvised explo-
sive device (IED) detonated under a mine-resistant ambush-
In this small sample of four combat medical cases, communi- protected vehicle (MRAP) in a convoy of U.S. Servicemembers.
cation errors threatened the MPE and overall medical combat Upon arrival, the team evaluated, triaged, and treated two ur-
mission. Similar to civilian literature, verbal miscommunica- gent surgical (category A) and two walking wounded (category
tion impacted medication administration, medical procedure C) casualties who had been pulled from the vehicle. Another
errors, and handoff errors. casualty was trapped in the MRAP and required extrication.
At the same time, a crowd of unknown foreign nationals was
Case Reports gathering 500m from the scene.
Case 1 The team leader sent the four casualties to the regional hospi-
A special operations team aboard a formation of CV-22 Os- tal aboard one helicopter with two PJs (one experienced and
preys was met with a barrage of enemy fire from multiple lo- one inexperienced). This PJ team had treated and delivered
cations during the insertion phase of a mission. The middle numerous patients to this hospital over the prior month, and
aircraft sustained four casualties from gunshot wounds, and they had repeated the same handoff routine each time. The
all aircraft were mechanically compromised. Multiple aerial established routine consisted of:
refuelings were required due to damage to aircraft hydraulic
and fuel systems. • Taking the patient out of the aircraft and loading him into
an ambulance on the flightline.
Three casualties required care, including hemorrhage control • Accomplishing a verbal handoff to the higher level of care
and analgesia. A medic treated the casualties en route during in the hospital trauma bay using the ATMIST (age, time,
the long flight back to the point of origin. While in flight on mechanism of injury, injuries, signs and symptoms, treat-
a different aircraft, three Air Force Pararescuemen (PJs) col- ments) format.
lected three units of fresh whole blood from matching donors • Handoff of a patient treatment card, which documents
on the security team in anticipation of treating the casualties trauma care provided prior to arrival at the hospital.
inbound on the CV-22. • Return to the helicopter and either return to base or pro-
ceed to the next mission.
Upon landing, the PJs met the medic and casualties at the land-
ing zone. The PJs began a blood transfusion on the casualty Given the circumstances, the goal was to hand off the four pa-
who was in shock. Shortly after, they were met by a contingent tients as quickly as possible at the helicopter landing pad and
of medical personnel who swarmed the scene and began to then immediately return to the incident site; the two PJs were
render care to the casualties prior to communicating with the to assist with the extrication of the fifth casualty who was
PJs or the medic. This resulted in three errors. trapped in the MRAP, which included providing security and
assistance for the rest of the team’s exfiltration.
The first error was a rapid push of whole blood. When this
incident occurred, the military medical protocol was to drip Upon arrival at the hospital, the junior PJ team member ac-
fresh whole blood slowly for 15 minutes to rule out a trans- companied the most critical patients onto the ambulance and
fusion reaction. No adverse reaction occurred, but this was a into the trauma bay rather than completing his handoff at the
violation of established protocol. helicopter. The senior PJ and aircrew noticed that the junior
PJ had disappeared. They tried to contact him on the radio
The second error was a medication overdose by the receiving but could not reach him. Due to operational constraints, they
medical personnel without direction from the primary medic or immediately returned to the incident site without the junior PJ.
any discussion of whether said medication was indicated, which
resulted in apnea. The apnea responded to a bag valve mask, but Once the rest of the team re-grouped at the incident site, the
this was a significant issue that increased patient risk, medical complicated extrication was performed, but unfortunately, the
team demand, and urgency/confusion in the overall treatment. casualty was deceased. Ultimately, the team was able to exfil-
trate with the deceased servicemember and another ambula-
The third error was the missed reduction and removal of the tory casualty. The PJ who had been separated from the team at
casualty’s upper leg tourniquet due to inadequate handoff to the hospital got back to base by other means.
the hospital, presumably further complicated by inadequate
assessment by the hospital. This resulted in a severe injury and, Although the mission was completed successfully, the tempo-
ultimately, amputation. rary loss of a team member resulted in an accountability error
and fewer operators to support security and extrication oper-
On the ground, there was no formal handoff from the PJs to ations for the small team. Upon completion of the extrication
the hospital medical team. Once the casualty arrived at the and return of the second helicopter, the now five-person team

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