Initial Assessment and Resuscitation of the Battlefield Casualty—an Overview

Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–7. Mabry RL, DeLorenzo R. Challenges to improving combat casualty survival on the battlefield. Mil Med. 2014;179(5):477–82. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983;249(2):28–35. Kotwal RS, Howard JT, Orman JA, Tarpey BW, Bailey JA, Champion HR, et al. The effect of a golden hour policy on the morbidity and mortality of combat casualties. JAMA Surg. 2016;151(1):15–24. Nessen SC, Gurney J, Rasmussen TE, et al. Unrealized potential of the US military battlefield trauma system: DOW rate is higher in Iraq and Afghanistan than in Vietnam, but CFR and KIA rate are lower. J Trauma Acute Care Surg. 2018;85(1S Suppl 2):S4–S12. Butler FK. Two decades of saving lives on the battlefield: tactical combat casualty care turns 20. Mil Med. 2017;182(3):e1563–8. • Callaway DW. Translating tactical combat casualty care lessons learned to the high-threat civilian setting: tactical emergency casualty care and the Hartford consensus. Wilderness Environ Med. 2017;28(2S):S140–5 The above reference discusses the prioritization of hemorrhage control over that of airway during the primary survey. Butler FK Jr. Fluid resuscitation in tactical combat casualty care: yesterday and today. Wilderness Environ Med. 2017;28(2S):S74–81. Butler FK, Holcomb JB, Schreiber MA, Kotwal RS, Jenkins DA, Champion HR, et al. Fluid resuscitation for hemorrhagic shock in tactical combat casualty care: TCCC guidelines change 14-01--2 June 2014. J Spec Oper Med. 2014;14(3):13–38. •• Butler FK Jr, Holcomb JB, Shackelford S, et al. Advanced resuscitative care in tactical combat casualty care: TCCC guidelines change 18–01:14 October 2018. J Spec Oper Med. 2020;18(4):37–55 The above reference outlines the key measures recommended by the CoTCCC for reducing NCTH related mortality. Kisat M, Morrison JJ, Hashmi ZG, Efron DT, Rasmussen TE, Haider AH. Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res. 2013;184(1):414–21. Maddry JK, Perez CA, Mora AG, Lear JD, Savell SC, Bebarta VS. Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study. Mil Med Res. 2018;5(1):22. Morrison JJ, Ross JD, Houston R, Watson JD, Sokol KK, Rasmussen TE. Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. Shock. 2014;41(2):130–7. Rasmussen TE, Eliason JL. Military-civilian partnership in device innovation: development, commercialization and application of resuscitative endovascular balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2017;83:732–5. Binz S, McCollester J, Thomas S, et al. CRASH-2 study of tranexamic acid to treat bleeding in trauma patients: a controversy fueled by science and social media. J Blood Transfus. 2015;2015:874920. Fisher AD, Carius BM, April MD, Naylor JF, Maddry JK, Schauer SG. An analysis of adherence to tactical combat casualty care guidelines for the administration of tranexamic acid. J Emerg Med. 2019;57(5):646–52. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113–9. Cap AP. CRASH-3: a win for patients with traumatic brain injury. Lancet. 2019;394(10210):1687–8. • collaborators C-t. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713–23 The above reference provides important recommendations for use of TXA in patients with TBI. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66(4 Suppl):S69–76. Nessen SC, Eastridge BJ, Cronk D, Craig RM, Berséus O, Ellison R, et al. Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets. Transfusion. 2013;53(Suppl 1):107S–13S. Alarhayem AQ, Myers JG, Dent D, Liao L, Muir M, Mueller D, et al. Time is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg. 2016;212(6):1101–5. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? J Trauma Acute Care Surg. 2012;73(6):1412–7. Kirkpatrick AW, Sirois M, Laupland KB, Liu D, Rowan K, Ball CG, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with Sonography for trauma (EFAST). J Trauma. 2004;57(2):288–95. Dan D, Mingsong L, Jie T, Xiaobo W, Zhong C, Yan L, et al. Ultrasonographic applications after mass casualty incident caused by Wenchuan earthquake. J Trauma. 2010;68(6):1417–20. Nations JA, Browning RF. Battlefield applications for handheld ultrasound. Ultrasound Q. 2011;27(3):171–6. Hodgetts TJ, Mahoney PF, Kirkman E. Damage control resuscitation. J R Army Med Corps. 2007;153(4):299–300. Woolley T, Thompson P, Kirkman E, et al. Trauma hemostasis and oxygenation research network position paper on the role of hypotensive resuscitation as part of remote damage control resuscitation. J Trauma Acute Care Surg. 2018;84(6S Suppl 1):S3–S13. Doran CM, Woolley T, Midwinter MJ. Feasibility of using rotational thromboelastometry to assess coagulation status of combat casualties in a deployed setting. J Trauma. 2010;69(Suppl 1):S40–8. Rasmussen TE, Dubose JJ, Asensio JA, Feliciano DV, Fox CJ, Nuñez TC, et al. Tourniquets, vascular shunts, and endovascular technologies: esoteric or essential? A report from the 2011 AAST military liaison panel. J Trauma Acute Care Surg. 2012;73(1):282–5. •• Johnson A, Rott M, Kuchler A, et al. Direct to operating room trauma resuscitation: optimizing patient selection and time-critical outcomes when minutes count. J Trauma Acute Care Surg. 2020;89(1):160–6 The above reference outlines important considerations for selecting patients for direct to operating room resuscitation. Martin M, Izenberg S, Cole F, Bergstrom S, Long W. A decade of experience with a selective policy for direct to operating room trauma resuscitations. Am J Surg. 2012;204(2):187–92. Comstock S, Pannell D, Talbot M, Compton L, Withers N, Tien HC. Spinal injuries after improvised explosive device incidents: implications for tactical combat casualty care. J Trauma. 2011;71(5 Suppl 1):S413–7. Smith JE, Midwinter M, Lambert AW. Avoiding cavity surgery in penetrating torso trauma: the role of the computed tomography scan. Ann R Coll Surg Engl. 2010;92(6):486–8. Martin MDJ. To operate or to image (Pulling the trigger). In: Martin MBA, Eckert M, editors. Front Line Surgery: A Practical Approach. 2nd ed. Berlin: Springer; 2017. Martin M, Beekley A, Eckert MJ. Front line surgery : a practical approach. Second ed. Cham: Springer; 2017.