«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 ...»
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.
J. CONCLUDING REMARKSPre-hospital combat death can be prevented by combatant and medical leaders at multiple
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.
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