Military experience and recent in vitro laboratory data provide a biological rationale for whole-blood use in the treatment of exsanguinating hemorrhage and have renewed interest in the reintroduction of fresh whole blood and cold-stored whole blood to patient care in austere environments. There is scant evidence to support, in a field environment, that a whole blood-based resuscitation strategy is superior to a crystalloid/colloid approach even when augmented by a limited number of red blood cell (RBC) and plasma units. Recent retrospective evidence suggests that, in this setting, resuscitation with a full compliment of RBCs, plasma, and platelets may offer an advantage, especially under conditions where evacuation is delayed. No current evacuation system, military or civilian, is capable of providing RBC, plasma, and platelet units in a prehospital environment, especially in austere settings. As a result, for the vast minority of casualties, in austere settings, with life-threatening hemorrhage, it is appropriate to consider a whole blood-based resuscitation approach to provide a balanced response to altered hemostasis and oxygen debt, with the goal of reducing the risk of death from hemorrhagic shock. To optimize the successful use of fresh whole blood/cold-stored whole blood in combat field environments, proper planning and frequent training to maximize efficiency and safety will be required. Combat medics will need proper protocol-based guidance and education if whole-blood collection and transfusion are to be successfully and safely performed in austere environments. In this article, we present the Norwegian Naval Special Operation Commando unit-specific remote damage control resuscitation protocol, which includes field collection and transfusion of whole blood. This protocol can serve as a template for others to use and adjust for their own military or civilian unit-specific needs and capabilities for care in austere environments.
Introduction: Tourniquet use has not been studied regarding specifically combat-intense military occupational specificities. This analysis examined the survivability, frequency of use, and nature of injuries in which tourniquets were employed among personnel in a single combat-specific military occupational specialty during combat operations. Methods: Injuries sustained by the combat-specific soldier, the cavalry scout, from 2003 to 2011 were identified using the Joint Theater Trauma Registry. Basic demographic information, mechanism of injury, injury characteristics, and mortality were recorded. Results: Of the 453 cavalry scouts wounded in action, 313 had adequate documentation upon arrival to a field hospital. Tourniquets were applied to 24 (7.7%) extremity wounds, 23 (96%) of these soldiers survived and one died of wounds (4.2%). Among those is in which tourniquets were used, there were seven (30%) senior enlisted and 16 (70%) junior enlisted soldiers with an average age of 24.8 years. Injuries were caused by gunshot wounds in 4 (17%), explosions in 18 (74%) and other mechanisms in two (8.3%). The primary reason for tourniquet application was open fracture (n ¼ 14, 61%), followed by vascular injury (n ¼ 5, 22%), and amputation (n ¼ 3, 13%). Other penetrating injuries were present in 19 (83%) of scouts. Conclusion: The high survivability of patients transported with tourniquet in place underscores the importance of battlefield tourniquet application. Continued focus on education and equipping combat personnel with tourniquets is critical to survivability of the injured solider.
Referring PAs can reliably discern unstable ankle fractures in more than 80% of cases. Lauge-Hansen classification was significantly less accurate than the Danis-Weber system or criteria for stability. Good communication between orthopedic surgeons and PAs and an emphasis on PA orthopedic education can improve patient care.
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