scholarly journals Trends in Prehospital Blood, Crystalloid, and Colloid Administration in Accordance With Changes in Tactical Combat Casualty Care Guidelines

2021 ◽  
Author(s):  
Emily E Clarke ◽  
James Hamm ◽  
Andrew D Fisher ◽  
Michael D April ◽  
Brit J Long ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Guideline Implementation ◽  
Fluid Administration ◽  
Blood Products ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Original Dataset ◽  
Freeze Dried ◽  
Combat Casualty Care

ABSTRACT Introduction Hemorrhage is the leading threat to the survival of battlefield casualties. This study aims to investigate the types of fluids and blood products administered in prehospital trauma encounters to discover the effectiveness of Tactical Combat Casualty Care (TCCC) recommendations. Materials and Methods This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry with a focus on prehospital fluid and blood administration in conjunction with changes in the TCCC guidelines. We collected demographic information on each patient. We categorized receipt of each fluid type and blood product as a binary variable for each casualty and evaluated trends over 2007–2020 both unadjusted and controlling for injury severity and mechanism of injury. Results Our original dataset comprised 25,897 adult casualties from January 1, 2007 through March 17, 2020. Most (97.3%) of the casualties were male with a median age of 25. Most (95.5%) survived to hospital discharge, and 12.2% of the dataset received fluids of any kind. Medical personnel used crystalloids in 7.4% of encounters, packed red blood cells in 2.0%, and whole blood in 0.5% with very few receiving platelets or freeze-dried plasma. In the adjusted model, we noted significant year-to-year increases in intravenous fluid administration from 2014 to 2015 and 2018 to 2019, with significant decreases noted in 2008–2009, 2010–2012, and 2015–2016. We noted no significant increases in Hextend used, but we did note significant decreases in 2010–2012. For any blood product, we noted significant increases from 2016 to 2017, with decreases noted in 2009–2013, 2015–2016, and 2017–2018. Overall, we noted a general spike in all uses in 2011–2012 that rapidly dropped off 2012–2013. Crystalloids consistently outpaced the use of blood products. We noted a small upward trend in all blood products from 2017 to 2019. Conclusions Changes in TCCC guidelines did not immediately translate into changes in prehospital fluid administration practices. Crystalloid fluids continue to dominate as the most commonly administered fluid even after the 2014 TCCC guidelines changed to use of blood products over crystalloids. There should be future studies to investigate the reasons for delay in guideline implementation and efforts to improve adherence.

scholarly journals Blood Product Administration During the Role 1 Phase of Care: The Prehospital Trauma Registry Experience

2020 ◽  
Author(s):  
Andrew D Fisher ◽  
Matthew W Paulson ◽  
Jerome T McKay ◽  
James Bynum ◽  
Kathleen M Flarity ◽  
...  
Keyword(s):  
Injury Severity ◽  
Blood Product ◽  
Trauma Registry ◽  
Outcome Data ◽  
Prehospital Setting ◽  
Body Region ◽  
High Survival ◽  
Blood Products ◽  
Severe Injuries ◽  
Freeze Dried

ABSTRACT Background The majority of combat deaths occur in the prehospital setting. Efforts to increase survival including blood transfusions are made in the prehospital setting. The blood products available in the Role 1 setting include whole blood (WB), red blood cells (RBCs), fresh frozen plasma (FFP), and lyophilized (freeze-dried) plasma (FDP). Methods This is a secondary analysis of a previously published dataset within the Prehospital Trauma Registry (PHTR) from 2003 through May 2019. Deterministic linking was used when possible with the DoD Trauma Registry for outcome data. Descriptive statistics were used to analyze the data. Results We identified 1,357 patient encounters in the PHTR. Within that group, 28 patients received a prehospital blood product, with 41 total administrations: WB (18), RBCs (12), FFP (6), FDP (3), and blood not otherwise specified (2). Outcome data were available for 17 of the 28 patients. The median injury severity score was 20, with the thorax being the most frequent seriously injured body region. Most (94%) patients survived to discharge. The median ICU days was 11 (Interquartile Range [IQR] 3-19), and the median hospital days was 19 (IQR 8-29). The average volume (units) of RBCs was 6.0 (95% CI 1.9-10.1), WB 2.8 (95% CI 0.0-5.6), platelets 0.7 (95% CI 0.0-1.4), and FFP 5.0 (95% CI 1.2-8.8). Conclusions The use of prehospital blood products is uncommon in U.S. combat settings. Patients who received blood products sustained severe injuries but had a high survival rate. Given the infrequent but critical use and potentially increased need for adequate prolonged casualty care in future near-peer conflicts, optimizing logistical chain circulation is required.

scholarly journals Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1271-e1276
Author(s):  
Stephen M Scott ◽  
Margaret J Carman ◽  
Michael E Zychowicz ◽  
Mark L Shapiro ◽  
Nicholas A True
Keyword(s):  
Prehospital Care ◽  
Preventable Death ◽  
Post Intervention ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Nasopharyngeal Airway ◽  
Austere Environment ◽  
Care Training ◽  
Combat Casualty Care ◽  
Paired T Test

Abstract Introduction The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force. Army Aviators are at risk for preventable death as they do not receive prehospital care training and are challenged to render prehospital care in the austere environment of helicopter operations. Army aviators are at risk for preventable death due to the challenges to render prehospital care in the austere environment of helicopter operations. Helicopters often fly at low altitudes, engage in direct action in support of ground troops, operate at a great distance from medical facilities, typically do not have medical personnel onboard, and can have long wait times for medical evacuation services due to the far forward nature of helicopter operations. Materials and Methods This is a quality improvement pre–post-intervention design study evaluating the implementation of a combat casualty care training program for Army aviators using well-established evidence-based guidelines for providing care to casualties on the battlefield. The evaluation consisted of participants’ self-perceived confidence in providing care to a casualty and change in knowledge level in combat casualty care in a pre/post-intervention design. Clinical skills of tourniquet application, nasopharyngeal airway placement, and needle chest decompression were assessed on a pass/fail grading standard. Results A total of 18 participants completed the pre- and post-education surveys. A paired t-test showed a statistically significant increase in total composite scores from pre (M = 24.67, SD = 5.06) to post-education self-efficacy (M = 37.94, SD = 2.10), t (17) = −11.29, p < 0.001. A paired t-test revealed a significant increase in exam scores from pre (M = 70.22, SD = 9.43) to post (M = 87.78, SD = 7.19), t (17) = −7.31, p < 0.001. There was no pre-intervention skills assessment, however, all participants (n = 18, 100%) passed the tourniquet application, needle chest compression, and insertion of nasopharyngeal airway. Conclusion TCCC for Army Aviators is easily implemented, demonstrates an increase in knowledge and confidence in providing prehospital care, and provides effective scenario-based training of necessary psychomotor skills needed to reduce preventable death on the battlefield. TCCC for Army Aviators effectively takes the TCCC for All Combatants curriculum and modifies it to address the unique considerations in treating wounded aviators and passengers, both in flight and after crashes. This project demonstrates on a small scale how TCCC can be tailored to specific military jobs in order to successfully meet the intent of the upcoming All Service Member TCCC course mandated in DoD 1322.24. Beyond Army aviation, this program is easily modifiable for aviators throughout the military and civilian sector.

Tactical Combat Casualty Care rules applied to civilian traumatic cardiopulmonary resuscitation

Resuscitation ◽  
2014 ◽  
Vol 85 (6) ◽  
pp. e85
Author(s):  
Nicolas Carbonnel ◽  
Pierre Pasquier ◽  
Mourad Bensalah ◽  
Clément Dubost ◽  
Stéphane Mérat
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Combat Casualty Care

scholarly journals Tactical Combat Casualty Care in Special Operations

1996 ◽  
Vol 161 (suppl_1) ◽  
pp. 3-16 ◽  
Author(s):  
Frank K. Butler ◽  
John Hagmann ◽  
E. George Butler
Keyword(s):  
Special Operations ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Combat Casualty Care

Massenanfall von Verletzten – Besonderheiten von „bedrohlichen Lagen“

2017 ◽  
Vol 52 (09) ◽  
pp. 618-629 ◽  
Author(s):  
Björn Hossfeld ◽  
Thomas Wurmb ◽  
Florent Josse ◽  
Matthias Helm
Keyword(s):  
Massenanfall Von Verletzten ◽  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Notfallmedizinische Versorgung ◽  
Combat Casualty Care

ZusammenfassungTerroristische Anschläge oder Amokläufe können Notärzte, Rettungsdienste, Feuerwehren und Katastrophenschutz in „bedrohliche Lagen“ bringen. Die Zusammenarbeit mit der Polizei ist dabei von herausragender Bedeutung. Um die Gefährdung für Hilfskräfte und Betroffene so gering wie möglich zu halten, richtet sich die notfallmedizinische Versorgung nach einsatztaktischen Grundsätzen. Als oberste Strategie bei solchen „bedrohlichen Lagen“ gilt: „Stopp the bleeding and clear the scene“. Die Polizei unterscheidet drei Gefährdungsbereiche: unsicher, teilsicher und sicher. Die Versorgung in diesen Bereichen folgt dem Konzept des Tactical Combat Casualty Care. Während im unsicheren Bereich ausschließlich Polizei eingesetzt werden sollte, kann nach entsprechenden Absprachen der Rettungsdienst im teilsicheren Bereich agieren. Sicherheit wird unter Umständen erst in Notaufnahmen erreicht, die durch verschiedene Maßnahmen zu sicheren Bereichen gemacht werden sollen.

scholarly journals Tactical combat casualty care in the navy – Challenges and way ahead

2019 ◽  
Vol 21 (2) ◽  
pp. 105
Author(s):  
Sougat Ray ◽  
MV Singh ◽  
Sunil Goyal ◽  
RJ Singh ◽  
Rohit Sharma
Keyword(s):  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Combat Casualty Care

Special Issues on Intraosseous Medicine - Part 1

2016 ◽  
Vol 11 (3) ◽  
pp. 143-218
Author(s):  
Richard A DeVito, Jr.
Keyword(s):  
Critically Ill Patients ◽  
Standard Of Care ◽  
Disaster Medicine ◽  
Blood Products ◽  
Intraosseous Access ◽  
Routes Of Administration ◽  
Combat Casualty ◽  
Life Saving ◽  
Medical Emergencies ◽  
Combat Casualty Care

Peripheral intravenous (IV) access can be difficult to achieve in critically ill patients who require vascular access in order to administer life-saving blood products, fluids and medications, especially in disasters and combat casualty care. Intraosseous access (IO) has become the standard of care for all medical emergencies, pre-hospital and hospital, when peripheral IV access cannot be rapidly established, and the techniques have been endorsed by multiple professional medical organizations. Research is rapidly expanding, both in the indications for IO, routes of administration, and clinical outcomes of intraosseous administration. The American Journal of Disaster Medicine is pleased to have the opportunity to publish two Special Issues1 focusing on current intraosseous research studies.

scholarly journals Tactical Combat Casualty Care 2007: Evolving Concepts and Battlefield Experience

2007 ◽  
Vol 172 (Supplement_1) ◽  
pp. 1-19 ◽  
Author(s):  
Frank K. Butler ◽  
Frank K. Butler ◽  
John B. Holcomb ◽  
Stephen D. Giebner ◽  
Norman E. McSwain ◽  
...  
Keyword(s):  
Tactical Combat Casualty Care ◽  
Combat Casualty ◽  
Combat Casualty Care
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