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«FINAL REPORT 30 January 2013 U.S. Central Command Pre-Hospital Trauma Care Assessment Team Russ S. Kotwal, MD MPH COL, MC, USA Director of Trauma ...»

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17. Review the use of c-collars and pelvic binders in TCCC.

18. Revisit the technique, training, and technology for surgical airways. Loss of consciousness in the absence of airway obstruction is not an indication for a surgical airway.

19. Review surgical airway indications. Surgical airways are being performed on casualties with GSWs to the head when there is no evidence of airway obstruction. Basic airway management techniques may be more appropriate.

20. Consider adding supraglottic airways as an airway option in Tactical Field Care as well as TACEVAC Care.

21. Simplify and clarify the TCCC airway algorithm.

22. As multiple deployed personnel noted training and placement of tourniquets exclusively in a “high and tight” versus simply proximal to extremity wound location, consider providing additional TCCC tourniquet placement clarification in TCCC instructional materials.

23. Consider adding the FemoStop compression device and other junctional pressure devices to the options for control of junctional hemorrhage.

24. Consider recommending the FAST-1 IO as the primary for TFC, and EZ IO as primary for TACEVAC.

25. Re-evaluate the role of the chest seal in the management of an open pneumothorax.

26. Provide additional clarification for use of Combat Ready Clamp to emphasize its potential improved employment when carried on evacuation platforms in a pre-assembled configuration.

27. Continue to investigate other options for hypothermia prevention.


Pre-hospital combat death can be prevented by combatant and medical leaders at multiple

levels through:

1. Primary prevention – prevent injury incident through TTPs and evidence-based findings from tactical and medical After Action Reviews (AARs)

2. Secondary prevention – mitigate injury extent through tactical contingency planning and Personal Protective Equipment (PPE)

3. Tertiary prevention – optimize injury care through properly executed TCCC, optimized tactical casualty response (POI and Evacuation), and forward damage control resuscitation

–  –  –

Medically, the key to trauma care delivery is the time to a required (injury dictated) capability (successfully performed). However, ultimately, the solution to trauma care delivery, and subsequent reduction of preventable combat death, is both tactical and medical, and therefore must have the attention and support of combatant commanders.

K. REFERENCES Butler FK, Hagmann J, Butler EG. Tactical Combat Casualty Care in Special Operations.

Military Medicine 1996; 161(suppl):1-15.

Butler FK, Blackbourne LH. Battlefield Trauma Care Then and Now: A Decade of Tactical Combat Casualty Care. Journal of Trauma and Acute Care Surgery 2012; 73(6) Suppl 5:395Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, OetjenGerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champion H, Moores L, Blackbourne LH. Death on the Battlefield (2001-2011): Implications for the Future of Combat Casualty Care. Journal of Trauma and Acute Care Surgery 2012; 73(6) Suppl 5:431-437.

Harris M, Baba R, Nahouraii R, Gould P. Self-induced Bleeding Diathesis in Soldiers at a FOB in South Eastern Afghanistan. Military Medicine 2012; 177(8):928-929.

Kelly JF, Ritenhour AE, McLaughlin DF, et al. Injury Severity and Causes of Death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. Journal of Trauma 2008; 64:S21-S27.

Kotwal RS, O’Connor KC, Johnson TR, Mosely DS, Meyer DE, Holcomb JB. A Novel Pain

Management Strategy for Combat Casualty Care. Annals of Emergency Medicine 2004; 44(2):


Kotwal RS, Montgomery HR, Kotwal BM, Champion HR, Butler FK, Mabry RL, Cain JS, Blackbourne LH, Mechler KK, Holcomb JB. Eliminating Preventable Death on the Battlefield.

Archives of Surgery 2011; 146:1350–1358.

Maughon JS. An Inquiry into the Nature of Wounds Resulting in Killed in Action in Vietnam.

Military Medicine 1970; 135:8-13.

Morrison JJ, Oh J, Dubose JJ, O’Reilly DJ, Russell RJ, Blackbourne LH, Midwinter MJ, Rasmussen TE. En-Route Care Capability From Point of Injury Impacts Mortality After Severe Wartime Injury. Annals of Surgery 2013; 257:330-334.

Puckett, R. Words of Wisdom: A Professional Soldier’s Notebook. Tucson:Wheatmark, 2007.

Smyth CH. The Joint Trauma Training Center: An Experiment in Military and Civilian Partnership for Trauma Training. American College of Healthcare Executives 2001.

Wedmore IS, Kotwal RS, McManus JG, Pennardt A, Talbot TS, Fowler M, McGhee L: Safety and Efficacy of Oral Transmucosal Fentanyl Citrate for Prehospital Pain Control on the Battlefield. Journal of Trauma and Acute Care Surgery 2012; 73(6) Suppl 5:490-495.

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