Page 11 - JSOM Fall 2025

FEATURE ARTICLES first-encounter CAT7/OMT applications, and second- versus first-
Lab Evaluation of Four Ukrainian-Manufactured Tourniquets: encounter SOFTTW3/SOFTTW5 applications. Occlusion at “Done”
With a cohort of 30 participants, Wall and colleagues analyzed four was more frequent with experienced appliers and did not show first-
Ukrainian-Manufactured Tourniquets—the Strengthened Individual use learning across all tourniquets in no-experience appliers. Occlusion
Combat Hybrid Tourniquet (SICH), TQ DNIPRO GEN 2 (DNIPRO), at “Done” indicated possible first-use learning with ratcheting-buckle
PULS tourniquet (PULS), and Yellow&Blue tourniquet (Y&B)—for versus windlass-rod tightening systems. Hook-and-loop strap security,
arterial occlusiveness, 180° turns, pressures, and reuse wear. They also which provides no inherent knowledge-of-results, showed no learn-
evaluated the design features of each device. The SICH, DNIPRO, and ing in experienced or no-experience appliers. These finding show that
PULS always reached completable arterial occlusion, while the Y&B while knowledge-of-results is critical for first-use learning, it does not
did not and had design concerns. The authors conclude that in general, guarantee it in this context. The existence of first-use learning can al-
180°-turn, windlass-rod-tightening-system resolution routinely creates low limited experience with one tourniquet to improve performance
much higher than needed and much higher than desirable pressures with a different tourniquet with shared-design features. Therefore,
at application completion, which likely matters with long tourniquet exposure to different designs may have value, and providing tourni-
times. Additionally, hook-and-loop-limb-encircling straps of current quet-training knowledge-of-results is important.
tourniquets, including the CAT, are too short to engage base-area- Accuracy of 6.5" Beaded Cable Tie, 10" Paracord, and Opera-
strap-securing mechanisms on many adult thighs. tor Gestalt in Prehospital Whole Blood Collection Techniques in
Filling Donor Blood Bags to Target Volume: With two groups of
Mitigating Heat Loss in IV Tubing During Austere Blood Transfu-
sions: Foust and Homan sought to determine the amount of heat lost experts (n=10) and novices (n=65), Carlton and colleagues compared
through IV tubing during blood transfusions in cold austere environ- the bag-fill accuracy of three prehospital whole blood collection tech-
ments. Using an incrementally cooled (by 3°C) environmental cham- niques: 6.5" beaded cable tie (BC), 10" paracord (PC), and operator
ber, the researchers conducted experiments, from a first collection at gestalt (OG). For novices, OG achieved the highest rate of correct fills,
20°C to a final collection at –39°C. They found that significant heat while PC had the highest rate of correct fills for experts, though it was
loss occurs through IV tubing during blood transfusions in these envi- not significantly different from the other techniques. BC performed
ronments (40.9 [SD 3.4] W lost, even at 20°C) and propose insulation poorly on all assessments, and the authors state it should be avoided.
as a primary mitigation strategy. However, thermal analysis indicates OG was generally superior to BC and PC, but was still suboptimal,
that insulation alone is not enough to maintain adequate fluid tem- with ~30% incorrect fills study wide, signalling the need for better
peratures in extreme cold conditions. methods for determining donor blood bag fill volume to preserve the
life of the wounded in walking blood bank settings.

Equipment included
in the Valkyrie Low-
Titer O Whole Blood
administration set.

Testing apparatus.
In-Theater Assessment of Resuscitative Balloon Occlusion of the
Aorta (REBOA) Capabilities and Training: Koo and colleagues eval- Antibiotic Concentrations After Massive Transfusion (ACME)
Study: A Review of the Literature on Antibiotic Dosing During
uated in-theatre resuscitative endovascular balloon occlusion of the
aorta (REBOA) capabilities at four medical treatment locations in Iraq Transfusion and Study Protocol: Huaman and colleagues present
their protocol for a prospective, multicenter study that will enroll
and Kuwait during the spring of 2019. Three of the four sites were
found to have had the minimum training and equipment to complete trauma patients from two large trauma centers: Brooke Army Medical
Center and the University of Colorado Hospital. The study group will
the procedure. However, the authors recommend improvements in
predeployment training of select medical personnel in REBOA and include participants receiving antibiotics for wound prophylaxis and
three or more units of blood products. The researchers hypothesize
arterial blood pressure monitoring to ensure adequate resourcing and
redundancy in training. that antibiotic concentrations decrease in proportion to the volume
of blood transfused, potentially leading to insufficient antibiotic con-
Search and Rescue Missions Conducted by the French Army Be- centrations, placing injured patients at increased risk of infection. This
tween 2015 and 2019: Gines and Thabouillot analyzed 175 search study’s results could help fill an important gap in trauma care by ex-
and rescue (SAR) mission reports from seven French metropolitan amining how transfusions affect the pharmacokinetics of antibiotic
bases between 2015 and 2019 to determine how many lives were levels.
saved. According to their estimates, 61 patients were in life- threatening Alternative Plasma Thawers for Austere Resuscitative Surgical
danger upon arrival of the SAR medical teams, accounting for more
than one-third of the patients rescued during the study period. This Teams: Literature Review: Filip and colleagues reviewed the litera-
ture to identify optimal alternative plasma thawing devices for Austere
analysis confirms the need for a deployable medical team competent
in emergency medicine, trained to work together, and aware of the Resuscitative and Surgical Care (ARSC) teams operating in far forward
settings, based on the devices’ power consumption, weight, durability,
difficulties of helicopter-based emergency care.
portability, post-thaw coagulation preservation, and thaw kinetics.
Across Tourniquet Designs First-Use Learning: Wall and colleagues The authors recommend that ARSC teams use whole blood, liquid
observed a subset of 10 experienced and 33 no-experience tourni- plasma, and FDA-approved thawing devices whenever available; how-
quet appliers from a previous study. The authors hypothesized that ever, alternative methods, such as sous vide warming, demonstrated
™
shared-design tourniquet features have useful first-use learning when potential. Dry-based thawing systems, such as the ZipThaw , may
knowledge-of-results occurs. Among no-experience appliers, first-use also offer advantages by conserving resources like water and electric-
learning was supported by faster “Go” to “strap secured” times for ity; however, further research is needed to validate their effectiveness
combined seventh and eighth versus first applications, second- versus in forward operating environments.
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