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.

Closing the "care in the air" capability gap for severe lung injury: the Landstuhl Acute Lung Rescue Team and extracorporeal lung support.

Background: The success of US Air Force Critical Care Air Transport Teams (CCATT) in transporting critically ill and injured patients enabled changes in military medical force deployment and casualty care practice. Even so, a subset of casualties remains who exceed even CCATT capabilities for movement. These patients led to the creation of the Landstuhl Acute Lung Rescue Team (ALeRT) to close the "care in the air" capability gap.

Intercontinental aeromedical evacuation of patients with traumatic brain injuries during Operations Iraqi Freedom and Enduring Freedom.

Traumatic brain injury contributes significantly to military combat morbidity and mortality. No longer maintaining comprehensive medical care facilities throughout the world, the US military developed a worldwide trauma care system making the patient the moving part of the system. Life-saving interventions are performed early, and essential care is delivered at forward locations.

Traumatic brain injury and aeromedical evacuation: when is the brain fit to fly?

Background: To review the inflammatory sequelae of traumatic brain injury (TBI) and altitude exposure and discuss the potential impact of aeromedical evacuation (AE) on this process.

Methods: Literature review and expert opinion regarding the inflammatory effects of TBI and AE.

Results: Traumatic brain injury has been called the signature injury of the current military conflict.

Air transport of patients with severe lung injury: development and utilization of the Acute Lung Rescue Team.

Background: Critical Care Air Transport Teams (CCATTs) are an integral component of modern casualty care, allowing early transport of critically ill and injured patients. Aeromedical evacuation of patients with significant pulmonary impairment is sometimes beyond the scope of CCATT because of limitations of the transport ventilator and potential for further respiratory deterioration in flight. The Acute Lung Rescue Team (ALRT) was developed to facilitate transport of these patients out of the combat theater.

Critical care at Landstuhl Regional Medical Center.

Background: Landstuhl Regional Medical Center is the largest U.S. medical facility outside the United States, and it is the first permanently positioned hospital outside the combat zone providing care to the wartime sick and wounded.

Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.

Background: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills.