Development and Characterization of a Self-Tightening Tourniquet System.

Uncontrolled hemorrhage remains a leading cause of death in both emergency and military medicine. Tourniquets are essential to stopping hemorrhage in these scenarios, but they suffer from subjective, inconsistent application. Here, we demonstrate how tourniquet application can be automated using sensors and computer algorithms.

Supervisory Algorithm for Autonomous Hemodynamic Management Systems.

Future military conflicts will require new solutions to manage combat casualties. The use of automated medical systems can potentially address this need by streamlining and augmenting the delivery of medical care in both emergency and combat trauma environments. However, in many situations, these systems may need to operate in conjunction with other autonomous and semi-autonomous devices.

Clinical impact of a prehospital trauma shock bundle of care in South Africa.

Introduction: Patients experiencing traumatic shock are at a higher risk for death and complications. We previously designed a bundle of emergency medical services traumatic shock care ("EMS-TruShoC") for prehospital providers in resource-limited settings. We assess how EMS-TruShoC changes clinical outcomes of critically injured prehospital patients.

Pathophysiology of Hemorrhage as It Relates to the Warfighter.

Saving lives of wounded military warfighters often depends on the ability to resolve or mitigate the pathophysiology of hemorrhage, specifically diminished oxygen delivery to vital organs that leads to multiorgan failure and death. However, caring for hemorrhaging patients on the battlefield presents unique challenges that extend beyond applying a tourniquet and giving a blood transfusion, especially when battlefield care must be provided for a prolonged period. This review describes these challenges and potential strategies for treating hemorrhage on the battlefield in a prolonged casualty care situation.

Evacuation Strategies for U.S. Casualties with Traumatic Brain Injury (TBI) with and without Polytrauma.

Introduction: According to the Military Health System Traumatic Brain Injury (TBI) Center of Excellence, 51,261 service members suffered moderate to severe TBI in the last 21 years. Moderate to severe TBI in service members is usually related to blast injury in combat operations, which necessitates medical evacuation to higher levels of care. Prevention of secondary insult, and mitigation of the unique challenges associated with the transport of TBI patients in a combat setting are important in reducing the morbidity and mortality associated with this injury.

Autoresuscitation of Poloxamer 188 in Pigs With Traumatic Severe Hemorrhage.

Background: Poloxamer 188 (P188) is a copolymer surfactant with plasma membrane stabilizing action. This study investigated the effects of P188 on blood volume and coagulation in pigs after traumatic hemorrhage and hypotensive resuscitation.

Methods: Femur fracture was performed in 17 anesthetized pigs, followed by hemorrhage of 55% of estimated blood volume and a 10 min shock period.

Prosthesis satisfaction and quality of life in US service members with combat-related major lower-limb amputation.

Background: Military amputee patient care programs offer extensive services, including advanced prosthetic devices, to restore function and improve quality of life (QOL) among veterans and service members with combat-related limb loss, but research on satisfaction with these devices is limited.

Objective: To assess prosthesis satisfaction and QOL in US service members and veterans with combat-related major lower-limb amputation.

Study Design: Cross-sectional study.

State of the Science in Tracheal Stents: A Scoping Review.

Objective: Recent material science advancements are driving tracheal stent innovation. We sought to assess the state of the science regarding materials and preclinical/clinical outcomes for tracheal stents in adults with benign tracheal disease.

Methods: A comprehensive literature search in April 2021 identified 556 articles related to tracheal stents.

The rebirth of the cool: a narrative review of the clinical outcomes of cold stored low titer group O whole blood recipients compared to conventional component recipients in trauma.

There has been renewed interest in the use of low titer group O whole blood (LTOWB) for the resuscitation of civilian casualties. LTOWB offers several advantages over conventional components such as providing balanced resuscitation in one bag that contains less additive/preservative solution than an equivalent volume of conventional components, is easier and faster to transfuse than multiple components, avoids blood product ratio confusion, contains cold stored platelets, and reduces donor exposures. The resurgence in its use in the resuscitation of civilian trauma patients has led to the publication of an increasing number of studies on its use, primarily amongst adult recipients but also in pediatric patients.

Autologous Lipoaugmentation Long-Term Clinical Outcomes: A Systematic Review.

Objectives/hypothesis: Vocal fold (VF) lipoaugmentation can be employed to treat glottal insufficiency although variable data exist on its length of effectiveness. We aimed to review published long-term outcomes following lipoaugmentation across the literature and compile outcome data.

Study Design: Systematic review.

Adherence to a Balanced Approach to Massive Transfusion in Combat Casualties.

Background: Hemorrhage is the most common cause of potentially preventable death on the battlefield. Balanced resuscitation with plasma, platelets, and packed red blood cells (PRBCs) in a 1:1:1 ratio, if whole blood (WB) is not available, is associated with optimal outcomes among patients with hemorrhage. We describe the use of balanced resuscitation among combat casualties undergoing massive transfusion.

An Analysis of Intracranial Hemorrhage in Wartime Pediatric Casualties.

Background: Children make up a significant cohort of patients treated at combat support hospitals. Where traumatic head injury, including intracranial hemorrhage (ICH), is well studied in military adults, such research is lacking regarding pediatric patients. We seek to describe the incidence and outcomes of ICH within this population.

In-Office Superior Laryngeal Nerve Block for Paralaryngeal Pain and Odynophonia.

Objectives: Pain localized to the thyrohyoid region may be due to neuralgia of the superior laryngeal nerve (SLN), inflammation of the thyrohyoid complex, or a voice disorder. We present outcomes of treatment of paralaryngeal pain and odynophonia with SLN block.

Study Design: Retrospective Review.

Settable Polymeric Autograft Extenders in a Rabbit Radius Model of Bone Formation.

Autograft (AG) is the gold standard for bone grafts, but limited quantities and patient morbidity are associated with its use. AG extenders have been proposed to minimize the volume of AG while maintaining the osteoinductive properties of the implant. In this study, poly(ester urethane) (PEUR) and poly(thioketal urethane) (PTKUR) AG extenders were implanted in a 20-mm rabbit radius defect model to evaluate new bone formation and graft remodeling.

Lessons Learned During Prolonged Care of Combat Casualties by a Minimally Manned Surgical Team.

In the current deployed environment, small teams are dispersed to provide damage control surgical capabilities within an hour of injury. Given the well-developed evacuation system, these teams do not typically have a significant patient hold capability. Improved understanding of the shortfalls and problems encountered when caring for combat casualties in prolonged care situations will facilitate improved manning, training, and equipping of these resource-limited teams.

Coagulation function of never frozen liquid plasma stored for 40 days.

Background: Never frozen liquid plasma (LP) has limited shelf life versus fresh frozen plasma (FFP) or plasma frozen within 24 h (PF24). Previous studies showed decreasing factor activities after Day (D)14 in thawed FFP but no differences between LP and FFP until D10. This study examined LP function through D40.

Intraoperative blood transfusions in burn patients.

Background: Donated blood is a valuable and limited resource. Excision of burn wounds often leads to significant blood loss requiring transfusion. Accurately estimating blood loss is difficult, so examining the amount of blood products given intraoperatively is a clinically relevant way to measure utilization of this valuable resource.

Hemorrhagic shock and hemostatic resuscitation in canine trauma.

Hemorrhage is a significant cause of death among military working dogs and in civilian canine trauma. While research specifically aimed at canine trauma is limited, many principles from human trauma resuscitation apply. Trauma with significant hemorrhage results in shock and inadequate oxygen delivery to tissues.

Joint Trauma System, Defense Committee on Trauma, and Armed Services Blood Program consensus statement on whole blood.

Hemorrhage is the most common mechanism of death in battlefield casualties with potentially survivable injuries. There is evidence that early blood product transfusion saves lives among combat casualties. When compared to component therapy, fresh whole blood transfusion improves outcomes in military settings.

Characterization of Vocal Fold Pathology in Military Drill Instructors.

Objective: Military drill instructors have extreme vocal demands that place them at risk for phonotrauma. Characterization of laryngeal pathology and vibratory characteristics among drill instructors presenting for specialized voice care is lacking.

Methods: A retrospective review in a specialized voice clinic over a two-year period was conducted.

Prolonged, High-Fidelity Simulation for Study of Patient Care in Resource-Limited Medical Contexts and for Technology Comparative Effectiveness Testing.

Unlabelled: Most high-fidelity medical simulation is of limited duration, used for education and training, and rarely intended to study medical technology. U.S.