Background: Casualties of military conflicts suffer a multitude of injuries, and recent research has documented a significant number develop acute respiratory distress syndrome (ARDS). The present study undertakes a scoping review of research on the treatment of ARDS in combat casualties near the battlefield.
Methods: We review the extent of the current ARDS care, from intubation and mechanical ventilation (MV) to the use of extracorporeal membrane oxygenation (ECMO), and how the respective echelons of care across the Military Health System (MHS) are involved in the care of these patients.
Background: Obtaining intravenous access in hypotensive patients is challenging and may critically delay resuscitation. The Graduated Vascular Access for Hypotensive Patient (GAHP) protocol leverages intraosseous fluid boluses to specifically dilate proximal veins. This study aims to evaluate the efficacy of GAHP in maximizing venous targets through early distal intraosseous access and a small fluid bolus.
View Article and Find Full Text PDFIntroduction: Airway management is a critical component of the management of emergency department (ED) patients. The ED airway literature primarily focuses upon endotracheal intubation; relatively less is known about the ED use of extraglottic devices (EGDs). The goal of this study was to describe the frequency of use, success, and complications for EGDs among ED patients.
View Article and Find Full Text PDFBackground: Airway obstruction is the second leading cause of potentially preventable death on the battlefield. The treatment for airway obstruction is intubation or advanced airway adjunct, which has a known risk of aspiration. We sought to describe the variables associated with aspiration pneumonia after prehospital airway intervention.
View Article and Find Full Text PDFIntroduction: Airway obstruction is the second leading cause of death on the battlefield. The harsh conditions of the military combat setting require that devices be able to withstand extreme circumstances. Military standards (MIL-STD) testing is necessary before devices are fielded.
View Article and Find Full Text PDFBackground: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. Assessing outcomes associated with airway interventions is important, and temporal trends can reflect the influence of training, technology, the system of care, and other factors. We assessed mortality among casualties undergoing prehospital airway intervention occurring over the course of combat operations during 2007-2019.
View Article and Find Full Text PDFBackground: Open fractures are at high risk for complications both in the military and civilian setting. Treatments to prevent fractures are limited in the Role 1 (prehospital, battalion aid station) setting. The goal of this study is to assess the efficacy of topical vancomycin powder, administered within 24 hours of an open fracture injury, in the prevention of infection and infection-related complications.
View Article and Find Full Text PDFIntroduction: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. The Committee on Tactical Combat Casualty Care (CoTCCC) has evolving recommendations for the optimal supraglottic airway (SGA) device for inclusion to the medics' aid bag.
Methods: We convened an expert consensus panel consisting of a mix of 8 prehospital specialists, emergency medicine experts, and experienced combat medics, with the intent to offer recommendations for optimal SGA selection.
Background: The US military's recent involvement in long standing conflict has caused the pioneering of many lifesaving medical advances, often made possible by data-driven research. However, future advances in battlefield medicine will likely require greater data fidelity than is currently attainable. Continuing to improve survival rates will require data which establishes the relative contributions to preventable mortality and guides future interventions.
View Article and Find Full Text PDFBackground: Prehospital surgical cricothyrotomies and complications from placement are an important and under-evaluated topic for both the military and civilian prehospital populations. This study uses the Department of Defense Trauma Registry to identify complications and the incidence of complications in prehospital combat surgical cricothyrotomies.
Methods: A secondary analysis of previously described prehospital-based dataset from the Department of Defense Trauma Registry (DODTR) was performed.
Large-scale combat and multi-domain operations will pose unprecedented challenges to the military healthcare system. This scoping review examines the specific challenges related to the management of airway compromise, the second leading cause of potentially preventable death on the battlefield. Closing existing capability gaps will require a comprehensive approach across all components of the Joint Capabilities Integration Development System.
View Article and Find Full Text PDFThere is no all-encompassing or universally accepted definition of the difficult airway, and it has traditionally been approached as a problem chiefly rooted in anesthesiology. However, with airway obstruction reported as the second leading cause of mortality on the battlefield and first-pass success (FPS) rates for out-of-hospital endotracheal intubation (ETI) as low as 46.4%, the need to better understand the difficult airway in the context of the prehospital setting is clear.
View Article and Find Full Text PDFAirway clearance refers to the clearing of any airway blockage caused due to foreign objects such as mud, gravel, and biomaterials such as blood, vomit, or teeth fragments using the technology of choice, portable suction devices. Currently available devices are either too heavy and bulky to be carried, or insufficiently powered to be useful despite being in accordance with the ISO 10079-1 standards. When applied to portable suction, the design and testing standards lack clinical relevancy, which is evidenced by how available portable suction devices are sparingly used in pre-hospital situations.
View Article and Find Full Text PDFIntroduction: Airway injuries are the second leading cause of potentially survivable battlefield death and often require airway management strategies. Airway suction, the act of using negative pressure in a patient's upper airway, removes debris that can prevent respiration, decreases possible aspiration risks, and allows clearer viewing of the airway for intubation. The most important characteristics for a portable airway suction device for prehospital combat care are portability, strong suction, and ease of use.
View Article and Find Full Text PDFBackground: Many advancements in supraglottic airway technology have occurred since the start of the Global War on Terrorism. While the Tactical Combat Casualty Care guidelines previously recommend the i-gel device, this is based on little data and minimal end-user input.
Objective: We sought to use a mixed methods approach to investigate the properties of an ideal device for inclusion into the medic's aid bag.
Background: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. The Committee on Tactical Combat Casualty Care lists airway optimization among the top 5 battlefield research and development priorities; however, studies show that combat medics lack access to the recommended supraglottic airway (SGA) devices. SGA devices are an alternative airway management technique to endotracheal tube intubation.
View Article and Find Full Text PDFIntroduction: Portable oxygen concentrators (POCs) are medical devices that use physical means to separate oxygen from the atmosphere to produce concentrated, medical-grade gas. Providing oxygen to low-resources environments, such as austere locations, military combat zones, rural Emergency Medical Services (EMS), and during disasters, becomes expensive and logistically intensive. Recent advances in separation technology have promoted the development of POC systems ruggedized for austere use.
View Article and Find Full Text PDFIntroduction: Airway obstruction is the second leading cause of potentially preventable death on the battlefield during the recent conflicts. Previous studies have noted challenges with enrolling medics using quantitative methods, with specific challenges related to limited prior experience with the devices presented. This limited the ability to truly assess the efficacy of a particular device.
View Article and Find Full Text PDFMed J (Ft Sam Houst Tex)
October 2021
Airway management is a foremost priority for combat medics treating battlefield casualties, as a compromised airway is the second leading cause of potentially survivable death on the battlefield, accounting for 1 in 10 preventable combat deaths. Effective suction is a critical component of airway clearance. However, currently available commercial devices are too heavy and bulky for combat medics to carry, and/or lack sufficient power to be useful.
View Article and Find Full Text PDFFor the past 25 years, the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Emergency Medicine Residency has used an end-of-shift evaluation (ESE) to provide formative feedback and assess resident progress. The instrument has evolved from a simple half-sheet of paper to a more complex electronic milestones assessment. The length and detail of the evaluation form has grown appreciably, but the precise impact of these changes on the effectiveness of formative feedback unknown.
View Article and Find Full Text PDFAcademic productivity is a requirement by the Accreditation Council for Graduate Medical Education (ACGME). In addition to the requirements by the ACGME, residency training programs are required to provide education on medical research with the end-goal of teaching physicians how to read, interpret, and apply medical evidence in the form of evidence-based medicine. An understanding of research design, evidencebased medicine, and critical appraisal of available literature is central to practicing medicine and applying new research to clinical practice.
View Article and Find Full Text PDFBackground: Failed airway management is the second leading cause of preventable death on the battlefield. The prehospital trauma registry (PHTR) after action-review (AAR) allows for unique perspectives and an enhanced analysis of interventions performed. We analyzed AAR comments related to airway interventions performed in deployed settings to examine and identify trends in challenges related to airway management in combat.
View Article and Find Full Text PDFMed J (Ft Sam Houst Tex)
October 2021
Airway management is one of the most challenging problems in prehospital combat casualty care. Airway assessment and intervention are second only to hemorrhage control in priority in the initial treatment of trauma patients, and airway compromise continues to account for approximately 1 in 10 preventable battlefield deaths. Combat medics often provide care in no- or low-light conditions, surrounded by the chaos of combat, and with the limited dexterity that accompanies bulky body armor, gloves, and heavy equipment.
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