Efficacy of Commercial Chest Seal Adherence and Tension Pneumothorax Prevention: A Systematic Review of Quantitative Studies.

Background: Penetrating thoracic injuries account for an essential subset of battlefield and civilian injuries that result in death. Current recommendations are to use commercially available nonocclusive chest seals. We review current evidence for which chest seal(s) is likely to be the most effective in treating open pneumothoraces.

The US military experience with THAM.

Background: Acidosis, a part of the lethal trauma triad, occurs frequently after major combat trauma. Tris-hydroxymethyl aminomethane (THAM) has been used to effectively treat acidosis in injured casualties. No research has been conducted assessing the safety of THAM in the military combat setting.

Prehospital Interventions Performed in Afghanistan Between November 2009 and March 2014.

Objective: Care provided to a casualty in the prehospital combat setting can influence subsequent medical interactions and impact patient outcomes; therefore, we aimed to describe the incidence of specific prehospital interventions (lifesaving interventions (LSIs)) performed during the resuscitation and transport of combat casualties.

Methods: We performed a prospective observational, IRB approved study between November 2009 and March 2014. Casualties were enrolled as they were cared for at nine U.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Hemorrhagic Shock.

This clinical practice guideline (CPG) reviews the range of accepted management approaches to profound shock and post-traumatic cardiac arrest and establishes indications for considering Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a hemorrhage control adjunct. The specific management approach - within the parameters of mission, resources, and tactical situation - will depend on the casualty's physical location, mechanism and pattern of injury, and the experience level of the surgeon. The optimal management strategy is best determined by the surgeon at the bedside.

Preinjury statin use and thromboembolic events in trauma: a 10-year retrospective evaluation.

Background: Traumatic injury is well known to increase the risk of venous thromboembolic events (VTEs), occurring in up to 58% of trauma patients. Statin medications have significant anti-inflammatory properties and have been shown to reduce the risk of VTE. We hypothesized that trauma patients who received statin medication before injury would have a lower incidence of VTE after injury.

Association between seatbelt sign and internal injuries in the contemporary airbag era: A retrospective cohort study.

Background: Literature predating routine availability of airbags reported an association between seatbelt signs and internal injuries. We measured this association among patients involved in motor vehicle crashes (MVCs) with airbag deployment.

Methods: We conducted a retrospective cohort study by chart review of all MVC patients presenting to our Emergency Department (ED) during 1 January 2008-30 September 2015.

Combat Casualties and Severe Shock: Risk Factors for Death at Role 3 Military Facilities.

Background: Although significant research has been conducted on combat casualties receiving blood products, there is limited data for the subpopulation presenting in shock. The purpose of this study was to evaluate combat casualties arriving to a role 3 facility with an initial systolic blood pressure (SBP) ≤ 90 in order to identify clinical characteristics and associations between presentation, transfusion therapy, and mortality outcomes.

Methods: The Department of Defense Trauma Registry was queried from 2001 to 2010 for trauma-related casualties who arrived at a role 3 combat surgical facility with a SBP ≤ 90.

Diagnostic accuracy of a novel software technology for detecting pneumothorax in a porcine model.

Introduction: Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography.

Methods: Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with a linear array transducer at 4cm of depth.

Incidence, risk factors, and mortality associated with acute respiratory distress syndrome in combat casualty care.

Background: The overall incidence and mortality of acute respiratory distress syndrome (ARDS) in civilian trauma settings have decreased over the past four decades; however, the epidemiology and impact of ARDS on modern combat casualty care are unknown. We sought to determine the incidence, risk factors, resource utilization, and mortality associated with ARDS in current combat casualty care.

Methods: This was a retrospective review of mechanically ventilated US combat casualties within the Department of Defense Trauma Registry (formerly the Joint Theater Trauma Registry) during Operation Iraqi Freedom/Enduring Freedom (October 2001 to August 2008) for ARDS development, resource utilization, and mortality.

The Effect of Hematocrit on Platelet Adhesion: Experiments and Simulations.

The volume fraction of red blood cells (RBCs) in a capillary affects the degree to which platelets are promoted to marginate to near a vessel wall and form blood clots. In this work we investigate the relationship between RBC hematocrit and platelet adhesion activity. We perform experiments flowing blood samples through a microfluidic channel coated with type 1 collagen and observe the rate at which platelets adhere to the wall.

U.S. Military Experience From 2001 to 2010 With Extremity Fasciotomy in War Surgery.

Introduction: After trauma, compartment syndrome of the extremities is a common, disabling, and-if managed suboptimally-lethal problem. Its treatment by surgical fasciotomy continues to be useful but controversial. The purpose of this survey is to measure survival and fasciotomy in a large trauma system to characterize trends and to determine if fasciotomy is associated with improved survival.

Computerized Diagnostic Assistant for the Automatic Detection of Pneumothorax on Ultrasound: A Pilot Study.

Introduction: Bedside thoracic ultrasound (US) can rapidly diagnose pneumothorax (PTX) with improved accuracy over the physical examination and without the need for chest radiography (CXR); however, US is highly operator dependent. A computerized diagnostic assistant was developed by the United States Army Institute of Surgical Research to detect PTX on standard thoracic US images. This computer algorithm is designed to automatically detect sonographic signs of PTX by systematically analyzing B-mode US video clips for pleural sliding and M-mode still images for the seashore sign.

Short-Term Outcomes and Complications of Damage Control and Definitive Laparotomy in Deployed Combat Environments: 2002 to 2011.

Introduction: Damage control laparotomy (DCL) in an austere environment is an evolving surgical modality.

Methods: A retrospective evaluation of all patients surviving 24 hours who underwent a laparotomy from 2002 to 2011 in Iraq and Afghanistan was performed. DCL was defined as a patient undergoing laparotomy at two distinct North American Treaty Organization (NATO) Role 2 or 3 medical treatment facilities (MTFs); a NATO Roles 2 and 3 MTFs, and/or having the International Classification of Diseases, 9th Revision, Clinical Modification procedure code 54.

Potentially preventable prehospital deaths from motor vehicle collisions.

Background: In 2011, about 30,000 people died in motor vehicle collisions (MVCs) in the United States. We sought to evaluate the causes of prehospital deaths related to MVCs and to assess whether these deaths were potentially preventable.

Methods: Miami-Dade Medical Examiner records for 2011 were reviewed for all prehospital deaths of occupants of 4-wheeled motor vehicle collisions.

The Combat Medic Aid Bag: 2025. CoTCCC Top 10 Recommended Battlefield Trauma Care Research, Development, and Evaluation Priorities for 2015.

While the list presented here is by no means a comprehensive list of all of the research areas of interest in battlefield trauma care, much less a list of research needs across the entire continuum of combat casualty care, it does provide the collective judgment of the CoTCCC about the highest priorities for RDT&E that relate to battlefield trauma care. Two additional observations should be made regarding that point: (1) As the landmark Eastridge et al. 2012 study convincingly documented, most combat fatalities occur in the prehospital phase of care, so research efforts that enable Combat medics, corpsmen, and PJs to care for their casualties more effectively will convey the highest probability of further reducing the case fatality rate and preventable deaths among US Combat casualties; and (2) inasmuch as the mission of the CoTCCC is to update the TCCC Guidelines as needed, this group has excellent visibility of the most important current research questions in battlefield trauma care.

Evaluation of the Effectiveness of the 2008 Postsplenectomy Vaccination Joint Theater Trauma System Clinical Practice Guideline.

Objectives: Postsplenectomy vaccination (PSV) in an austere environment to minimize overwhelming postsplenectomy infection is challenging. We evaluated the clinical impact of a March 2008 clinical practice guideline (CPG) dictating immediate PSV at North American Treaty Organization Role 3 medical treatment facilities and subsequent complications.

Methods: Utilizing U.

Early in-theater management of combat-related traumatic brain injury: A prospective, observational study to identify opportunities for performance improvement.

Background: Combat-related moderate-to-severe traumatic brain injury (CRTBI) is a significant cause of wartime morbidity and mortality. As of August 2014, moderate-to-severe traumatic brain injuries sustained by members of the Department of Defense worldwide since 2000 totaled 32,996 cases. Previously published epidemiologic reviews describe CRTBI management at a "strategic" level, but they lack "tactical" patient-specific data required for performance improvement.

Military-to-civilian translation of battlefield innovations in operative trauma care.

Background: Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care.

An 8-year review of operation enduring freedom and operation iraqi freedom resuscitative thoracotomies.

Background: Appropriate indications for resuscitative thoracotomy (RT) in an austere environment continue to evolve; the aim of this study was to determine survival and to analyze demographics of survivors within U.S. military personnel undergoing RT.

Nonoperative management of splenic injury in combat: 2002-2012.

Background: Selective nonoperative management of combat-related blunt splenic injury (BSI) is controversial. We evaluated the impact of the November 2008 blunt abdominal trauma clinical practice guideline that permitted selective nonoperative management of some patients with radiological suggestion of hemoperitoneum on implementation of nonoperative management (NOM) of splenic injury in austere environments.

Methods: Retrospective evaluation of patients with splenic injuries from November 2002 through January 2012 in Iraq and Afghanistan was performed.

Transfusion for shock in US military war casualties with and without tourniquet use.

Study Objective: We assess whether emergency tourniquet use for transfused war casualties admitted to military hospitals is associated with survival.

Methods: A retrospective review of trauma registry data was made of US casualties in Afghanistan and Iraq. Patients with major limb trauma, transfusion, and tourniquet use were compared with similar patients who did not receive tourniquet use.

U.S. Military use of tourniquets from 2001 to 2010.

Objective: This study was conducted to associate tourniquet use and survival in casualty care over a decade of war in order to provide evidence to emergency medical personnel for the implementation and efficacy of tourniquet use in a large trauma system.

Methods: This survey is a retrospective review of data extracted from a trauma registry. The decade (2001-2010) outcome trend analysis of tourniquet use in the current wars was made in order to associate tourniquet use and survival in an observational cohort design.

Fluid Resuscitation for Hemorrhagic Shock in Tactical Combat Casualty Care: TCCC Guidelines Change 14-01--2 June 2014.

This report reviews the recent literature on fluid resuscitation from hemorrhagic shock and considers the applicability of this evidence for use in resuscitation of combat casualties in the prehospital Tactical Combat Casualty Care (TCCC) environment. A number of changes to the TCCC Guidelines are incorporated: (1) dried plasma (DP) is added as an option when other blood components or whole blood are not available; (2) the wording is clarified to emphasize that Hextend is a less desirable option than whole blood, blood components, or DP and should be used only when these preferred options are not available; (3) the use of blood products in certain Tactical Field Care (TFC) settings where this option might be feasible (ships, mounted patrols) is discussed; (4) 1:1:1 damage control resuscitation (DCR) is preferred to 1:1 DCR when platelets are available as well as plasma and red cells; and (5) the 30-minute wait between increments of resuscitation fluid administered to achieve clinical improvement or target blood pressure (BP) has been eliminated. Also included is an order of precedence for resuscitation fluid options.