scholarly journals Torso body armour coverage defined according to feasibility of haemorrhage control within the prehospital environment: a new paradigm for combat trauma protection

2020 ◽  
pp. bmjmilitary-2020-001582
Author(s):  
Johno Breeze ◽  
D M Bowley ◽  
D N Naumann ◽  
M E R Marsden ◽  
R N Fryer ◽  
...  
Keyword(s):  
Damage Control ◽  
Medical Knowledge ◽  
Damage Control Surgery ◽  
Combat Trauma ◽  
Medical Terminology ◽  
New Paradigm ◽  
Anatomical Structures ◽  
Haemorrhage Control ◽  
Systems Requirements ◽  
Requirements Document

Developments in military personal armour have aimed to achieve a balance between anatomical coverage, protection and mobility. When death is likely to occur within 60 min of injury to anatomical structures without damage control surgery, then these anatomical structures are defined as ‘essential’. However, the medical terminology used to describe coverage is challenging to convey in a Systems Requirements Document (SRD) for acquisition of new armour and to ultimately translate to the correct sizing and fitting of personal armour. Many of those with Ministry of Defence responsible for the procurement of personal armour and thereby using SRDs will likely have limited medical knowledge; therefore, the potentially complex medical terminology used to describe the anatomical boundaries must be translated into easily recognisable and measurable external landmarks. We now propose a complementary classification for ballistic protection coverage, termed threshold and objective, based on the feasibility of haemorrhage control within the prehospital environment.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an adjunct to damage control surgery for combat trauma

2017 ◽  
Vol 1 (1) ◽  
pp. 58-62
Author(s):  
Jacob J Glaser ◽  
William Teeter ◽  
Travis Gerlach ◽  
Nathanial Fernandez
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Combat Trauma ◽  
Operating Table ◽  
Vascular Control ◽  
Resuscitative Thoracotomy ◽  
Combat Casualty ◽  
Transfusion Requirements ◽  
Endovascular Balloon Occlusion

Background: Non compressible torso hemorrhage continues to be the leading cause of preventable death in combat operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative hemorrhage control strategy, with morbidity advantages over resuscitative thoracotomy. We report the first ever use of REBOA in a combat casualty in Afghanistan. Case Report: An 18 year old Afghan male was injured by a single high velocity gunshot wound during partnered operations. He was treated with a damage control operation at the role 2 level, with significant presacral and pelvic bleeding controlled with combat gauze packing. The patient continued to be hemodynamically labile, with ongoing transfusion requirements and required emergent re-exploration.  Upon transfer from the gurney to the operating table the patient was noted to be hypotensive with a blood pressure of 62/38. An ER-REBOA catheter was measured for Zone 1 occlusion and placed without difficulty. The patient’s hemodynamics normalized, which allowed for sterile entry into the abdomen and vascular control. After 10 minutes of occlusion the balloon was deflated. Surgical repair was completed and patient survived to discharge. Conclusions:  REBOA is an adjunct to hemorrhagic shock that provides temporary proximal control bridge to definitive surgical hemostasis while avoiding the morbidity of a resuscitative thoracotomy. This case represents the first reported use of REBOA in the Afghanistan Theater. This case further supports increased consideration for use of REBOA in the forward setting.

scholarly journals REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting

2017 ◽  
Vol 164 (2) ◽  
pp. 72-76 ◽  
Author(s):  
Paul Rees ◽  
B Waller ◽  
A M Buckley ◽  
C Doran ◽  
S Bland ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Operating Table ◽  
Royal Navy ◽  
Future Directions ◽  
Haemorrhage Control ◽  
Aviation Operations ◽  
The Military ◽  
Endovascular Balloon Occlusion

Role 2 Afloat provides a damage control resuscitation and surgery facility in support of maritime, littoral and aviation operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a rapid, effective solution to exsanguinating haemorrhage from pelvic and non-compressible torso haemorrhage. It should be considered when the patient presents in a peri-arrest state, if surgery is likely to be delayed, or where the single operating table is occupied by another case. This paper will outline the data in support of endovascular haemorrhage control, describe the technique and explore how REBOA could be delivered using equipment currently available in the Royal Navy Role 2 Afloat equipment module. Also discussed are potential future directions in endovascular resuscitation.

scholarly journals Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

2013 ◽  
Vol 95 (3) ◽  
pp. 177-183 ◽  
Author(s):  
AE Sharrock ◽  
M Midwinter
Keyword(s):  
Trauma Care ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Management Plan ◽  
Ovid Medline ◽  
Patient Will ◽  
Trauma Networks ◽  
Haemorrhage Control ◽  
The Individual ◽  
The Uk

Introduction Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. Methods The Ovid MEDLINE®, EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. Findings A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome.

Team-Oriented Training for Damage Control Surgery in Rural Trauma: A New Paradigm

2008 ◽  
Vol 64 (4) ◽  
pp. 949-954 ◽  
Author(s):  
Kari Schrøder Hansen ◽  
Per E. Uggen ◽  
Guttorm Brattebø ◽  
Torben Wisborg
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
New Paradigm

scholarly journals Damage control resuscitation: REBOA as the new fourth pillar

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Jose Julian Serna ◽  
Fernando Rodriguez ◽  
Alberto Garcia ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Metabolic Decompensation ◽  
Severely Injured ◽  
Damage Control Resuscitation ◽  
New Paradigm ◽  
Permissive Hypotension ◽  
Hemostatic Resuscitation

Damage Control Resuscitation (DCR) seeks to combat metabolic decompensation of the severely injured trauma patient by battling on three major fronts: Permissive Hypotension, Hemostatic Resuscitation, and Damage Control Surgery (DCS). The aim of this article is to perform a review of the history of DCR/DCS and to propose a new paradigm that has emerged from the recent advancements in endovascular technology: The Resuscitative Balloon Occlusion of the Aorta (REBOA). Thanks to the advances in technology, a bridge has been created between Pre-hospital Management and the Control of Bleeding described in Stage I of DCS which is the inclusion and placement of a REBOA. We have been able to show that REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured blunt and/or penetrating trauma patient. That is why we propose a new paradigm “The Fourth Pillar”: Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA.

Chronic mesenteric ischaemia presenting as possible large bowl malignancy: an easily overlooked differential diagnosis

2021 ◽  
Vol 14 (3) ◽  
pp. e240202
Author(s):  
Benjamin McDonald
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Weight Loss ◽  
Differential Diagnosis ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Mesenteric Ischaemia ◽  
Abdominal Symptoms ◽  
Chronic Mesenteric Ischaemia ◽  
Descending Colon

An 80-year-old woman presented to a regional emergency department with postprandial pain, weight loss and diarrhoea for 2 months and a Computed Tomography (CT) report suggestive of descending colon malignancy. Subsequent investigations revealed the patient to have chronic mesenteric ischaemia (CMI) with associated bowel changes. She developed an acute-on-chronic ischaemia that required emergency transfer, damage control surgery and revascularisation. While the patient survived, this case highlights the importance of considering CMI in elderly patients with vague abdominal symptoms and early intervention to avoid potentially catastrophic outcomes.

Damage control surgery

2021 ◽  
Vol 21 (S1) ◽  
pp. 147-154
Author(s):  
C. Güsgen ◽  
A. Willms ◽  
R. Schwab
Keyword(s):  
Damage Control ◽  
Damage Control Surgery
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