Page 80 - JSOM Spring 2025

An Ongoing Series

Optimal Prehospital Practices for Airway Emergencies
of Military Working Dog Combat Casualties

Lee Palmer, DVM, MS, DACVECC, CCRP, EMT-T, NRP, TP-C ; Suzanne Skerrett, DVM, DACVS ;
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Emilee C. Venn, DVM, MS, DACVECC ; Arezoo Mohammadipoor, DVM, PhD ;
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Thomas H. Edwards, DVM, MS, DACVECC *
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ABSTRACT
Purpose: This study evaluated the feasibility of performing obstructions (UAO) remain a potentially survivable cause of
a surgical cricothyrotomy (CTT) in lieu of a tube tracheos- combat-related fatalities in MWDs; however, supporting evi-
tomy (TT) as the first-line emergent surgical airway access dence to guide best practice management for UAOs is lacking.
technique in military working dogs (MWDs). Methods: In a Surgical cricothyrotomy (CTT) and surgical tube tracheos-
crossover, randomized trial, five emergency medicine physician tomy (TT) constitute the two options for performing an out-
residents (MD group), trained in performing CTT in people of- hospital emergent surgical airway. CTT is the preferred,
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but not canines, and five early career veterinarians (DVM almost exclusively practiced, technique in humans, whereas
group), trained in performing TT in canines but not trained TT is rarely described or taught in the current human-based
in performing CTT in canines, performed a CTT and TT on prehospital training curriculums and programs. Tradition-
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10 canine cadavers. Results: The time to complete CTT within ally, the veterinary literature referenced TT as the primary
the MD group was statistically shorter than the time to com- emergent surgical airway for canines with infrequent mention
plete TT (P<.05). In the DVM group, the time to complete of CTT. Recently, the predominant use and success of CTT
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TT was shorter than that of CTT, but the time difference was in human battlefield medicine sparked an interest within the
not statistically significant (CTT: 239.6 [SD 251.7] s vs. TT: veterinary community to evaluate CTT as a viable first-line
133.4 [SD 88.0] s). In the MD group, the TT damage score emergent surgical airway for MWDs. 8–11 The 2018 MWD
was statistically higher than the CTT damage score (CTT: 0 vs. clinical practice guidelines (CPGs) recommended only TT for
TT: 1.6 [SD 0.9], P<.01). There was no statistically significant MWDs with UAO, while the 2023 canine Tactical Combat
difference between the damage scores of CTT and TT in the Casualty Care (K9TCCC) guidelines describe both CTT and
DVM group (CTT: 1.4 [SD 1.1] vs. TT: 1.6 [SD 0.9]). Overall, TT without recommending one over the other. 9,10 Updates to
the participants reported a positive response with CTT com- the MWD CPGs, currently under review, will mirror the 2023
pared to TT. Conclusion: CTT is a viable first-line emergent K9TCCC recommendations by listing both CTT and TT as
surgical airway access technique when used by veterinarians viable emergent airway access techniques in MWDs without
and human healthcare clinicians with limited surgical experi- recommending one over the other. Although a paucity of pub-
ence or no proficiency in performing TT. lished data supports CTT as a feasible, technically simple, and
rapid procedure for achieving emergent airway access in ca-
Keywords: tracheostomy; cricothyrotomy; military working nines, scientific data evaluating the clinical use and advantage
dog; difficult airway; airway obstruction of CTT over TT in canines is limited. 11,14–16
Considering the purported benefits of CTT over TT, including
the retention of skill-based technical proficiency, it seems that
Introduction
CTT, presumptively, offers a greater potential for reducing
Critical knowledge gaps exist in point-of-injury (POI) battle- case fatality rates in MWDs with UAOs. 1,8,11 Between fulfilling
field care for the military working dog (MWD). Upper airway clinic hours and maintaining their current level of skill-based
*Correspondence to Thomas Edwards, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX, USA or
thomas.h.edwards.civ@health.mil
1 COL Lee Palmer is the senior DIMA veterinarian for Army Veterinary Services, Aberdeen Proving Grounds, Aberdeen, MD and contract veter-
inarian for 24th Special Operations Wing, Hurlburt Field, FL. LTC Suzanne Skerrett is the chief of the Animal Health Branch, Medical Center
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of Excellence, JBSA Fort Sam Houston, TX. LTC Emilee C. Venn is the commander of the 106th MED DET (VSS) and Veterinary Readiness
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Activity, Korea. Dr. Arezoo Mohammadipoor is a research scientist at the U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, TX.
5 LTC (R) Thomas H. Edwards is the scientific lead for the Hemorrhage Control and Vascular Dysfunction department in the U.S. Army Institute
of Surgical Research, JBSA Fort Sam Houston, TX and an associate professor at the College of Veterinary Medicine, Texas A&M University,
College Station, TX.
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