Page 85 - JSOM Fall 2025

respirations of 14 breaths per minute, and blood pressure of Case 9
80mmHg over palpation. The medic applied occlusive dress- The patient was wounded during insertion of a ground assault
ing, gained intravenous (IV) access, and provided 500cc of force by small arms fire to the left axilla while manning a ramp-
HEXTEND and 500cc of normal saline, antibiotics, and an- mounted, crew-served weapon on a helicopter. He was immedi-
algesia. The patient was evacuated without incident 50 min- ately attended to by an onboard medic who found the patient
utes later to the forward surgical team. Follow-up care was alert without immediate signs of shock. The medic immediately
significant for bowel and mesenteric injuries. The patient was applied an occlusive dressing and achieved IV access while en
successfully evacuated from the theater. Front, rear, and side route. No further interventions were recorded en route, and he
plates had been worn at the time of injury. Final Disposition: was received by the forward surgical team, which placed a left
Wounded in Action tube thoracostomy without future recorded interventions. The
patient returned to full duty three weeks later. Front, rear, and
Case 7 side plates had been worn at the time of injury. Final Disposi-
The patient was conducting a dismounted patrol when he was tion: Wounded in Action.
shot through the right first rib. The first responder immediately
applied occlusive dressing. The patient lost consciousness upon Case 10
evaluation by medic, and needle decompression was completed The patient was wounded during a dismounted patrol when
at 2nd intercostal space. Pulses were lost and patient received he was struck in the left axilla by small arms fire resulting in a
30 minutes of CPR on scene with a King LTS-D Disposable single penetrating wound. He was tended to on scene by medics
™
Laryngeal Tube (Ambu, Columbia, MD) placed for airway for 1 hour, with an occlusive dressing being the only recorded
management. The patient was declared DOA at forward sur- intervention. He was then evacuated to the forward surgical
gical team. Autopsy was notable for laceration of right upper team, which placed a left tube thoracostomy for suspected he-
lobe of the lung, aortic laceration, left upper lobe lung lacera- mopneumothorax. Chest tube output was not recorded. Final
tion, and tracheal transection, as well as the thoracic needle not recorded interventions included operating room thoracotomy
entering the chest cavity. Front, rear, and side plates had been with left lower lobectomy and repaired flail chest. Front, rear,
worn at the time of injury. Final Disposition: Killed in Action. and side plates had been worn at the time of injury. Final Dis-
position: Wounded in Action.
Case 8
The patient was conducting dismounted raid operations when Case 11
he was shot in the right 4th ICS and wounded by an enemy The patient sustained a penetrating wound to the right upper
grenade while in the open. Immediate aid was rendered by arm and axilla during dismounted patrol. The first responder
medics on scene who found an alert and oriented patient with placed a tourniquet to the right arm with occlusive dressing
an axilla wound with visible air bubbling. Occlusive dressing on the chest and performed immediate needle decompression.
was applied to the penetrating wound, and needle decompres- When the patient was reassessed by medics, they converted
sion of the right 2nd ICS performed. The patient was then the tourniquet to a pressure dressing along with obtaining IV
moved to the casualty collection point where IV access was access and administering analgesia. The patient was alert, ori-
obtained and 500cc of HEXTEND was administered along ented and ambulatory throughout. The patient was transported
with analgesia. The patient continued to be alert. The patient to the forward surgical team within an hour; once there they
was then moved to the helicopter landing zone where a radial received a right tube thoracostomy without documentation of
pulse was noted, and three additional needle decompressions output, and owing to concern for brachial artery injury, was
were performed. Once transferred to the MEDEVAC aircraft, taken to the operating room for extremity exploration. The
the enroute medic noted that the patient had a Glasgow Coma patient remained intubated for 48 hours for transport to Role
Scale (GCS) 15 and was conversant. During flight, the pa- 3 for venous graft and follow-on transport to Germany. The
tient again developed respiratory distress, which resulted in patient was extubated without further recorded operations or
reassessment of occlusive dressings along with two additional complications. Front, rear, and side plates had been worn at
needle decompressions. The medic noted no obvious signs of the time of injury. Final Disposition: Wounded in Action.
external hemorrhage. The patient was transferred to the for-
ward surgical team with a GCS of 15, 70 minutes after injury, Discussion
with a heart rate of 118, blood pressure 107/63mmHg and
absent peripheral pulses per surgical team documentation. The Armor Efficacy
airway was then secured through rapid sequence intubation Review of the data indicates multiple trends that support the
prior to continuing the survey. Frank blood was seen when efficacy of the four-plate system in reducing mortality. While
the chest seal was opened; it was resealed, and a chest tube overall mortality was less than half, there was a 100% mortal-
placed with 850cc of bloody output. Two units of packed red ity for patients who sustained wounds to the side-plate region
blood cells (PRBC) and 1 unit fresh frozen plasma (uFFP) were while wearing the two-plate system. This compares to 25%
infused. Ten minutes later, the patient developed Pulseless Elec- mortality for those receiving wounds outside the side-plate
trical Activity (PEA) arrest and received CPR and resuscitative coverages, regardless of armor configuration. Additionally, the
thoracotomy. ROSC was not achieved after 1mg epinephrine, one patient who was wounded in the side-plate region while
1g calcium chloride, 2 amps of sodium bicarbonate, 6 units of wearing the four-plate configuration survived with the round
PRBCs, and 4 units of FFP. Autopsy was significant for lac- appearing to be redirected inferiorly. While the sample size is
eration of the right lung and right liver lobe, perforated right small, presented data support the lethality of injuries to the
hemidiaphragm, right periadrenal hemorrhage, and 1,000cc of area covered by side plates and, with a sample size of one, sug-
blood in the abdomen and right chest and a posterior lumbar gest that side plates can prevent lethal injury. This suggestion
exit wound. Front, rear, and side plates had been worn of the is supported by a forensic analysis on all ceramic plate im-
time of injury. Final Disposition: Killed in Action. pacts from 2015, conducted by the Joint Analysis of Trauma

Axilla Injuries and Ceramic Plate Coverage | 83