TCCC General Topics

#### TCCC GENERAL TOPICS

J Trauma Acute Care Surg. 2019 Jan 10; Epub ahead of print

# The "top 10" Research and Development Priorities for Battlefield Surgical Care: Results From the Committee on Surgical Combat Casualty Care Research gap Analysis.

Martin M, Holcomb J, Polk T, Hannon M, Eastridge B, Malik S, Blackman V, Galante J, Grabo D, Schreiber M, Gurney J, Butler F, Shackelford S.

BACKGROUND: The US Military has achieved the highest casualty survival rates in its history. However, there remain multiple areas in combat trauma that present challenges to the delivery of high quality and effective trauma care. Previous work has identified research priorities for pre-hospital care, but there has been no similar analysis for forward surgical care.

METHODS: A list of critical "focus areas" was developed by the Committee on Surgical Combat Casualty Care (CoSCCC). Individual topics were solicited and mapped to appropriate focus areas by group consensus and review of EAST and JTS guidelines. A web-based survey was distributed to the CoSCCC and the military committees of EAST and AAST. Topics were rated on a Likert scale from 1 (low) to 10 (high priority). Descriptives, univariate statistics, and inter-rater correlation analysis was performed.

RESULTS: 13 research focus areas were identified (8 clinical and 5 adjunctive categories). Ninety individual topics were solicited. The survey received 64 responses. The majority of respondents were military (90%) versus civilians (10%). There was moderate to high agreement (inter-rater correlation coefficient=0.93, p<0.01) for 10 focus areas. The top 5 focus areas were Personnel/Staffing (mean=8.03), Resuscitation & Hemorrhage Management (7.49), Pain/Sedation/Anxiety Management (6.96), Operative Interventions (6.9), and Initial Evaluation (6.9). The "Top 10" research priorities included 4 in Personnel/Staffing, 4 in Resuscitation/Hemorrhage Management, and 3 in Operative Interventions. A complete list of the topics/scores will be presented.

CONCLUSIONS: This is the first objective ranking of research priorities for combat trauma care. The "Top 10" priorities were all from 3 focus areas, supporting prioritization of personnel/staffing of austere teams, resuscitation/hemorrhage control, and damage control interventions. This data will help guide DOD research programs and new areas for prioritized funding of both military and civilian researchers.

J Spec Oper Med. Winter 2018;18(4):34-35.

# Use of Drone Technology for Delivery of Medical Supplies During Prolonged Field Care.

Mesar T, Lessig A, King DR.

BACKGROUND: Care of trauma casualties in an austere environment presents many challenges, particularly when evacuation is not immediately available. Man-packable medical supplies may be consumed by a single casualty, and resupply may not be possible before evacuation, particularly during prolonged field care scenarios. We hypothesized that unmanned aerial drones could successfully deliver life-sustaining medical supplies to a remote, denied environment where vehicle or foot traffic is impossible or impractical.

METHODS: Using an unmanned, rotary- wing drone, we simulated delivery of a customizable, 4.5kg load of medical equipment, including tourniquets, dressings, analgesics, and blood products. A simulated casualty was positioned in a remote area. The flight was preprogrammed on the basis of grid coordinates and flew on autopilot beyond visual range; data (altitude, flight time, route) were recorded live by high-altitude Shadow drone. Delivery time was compared to the known US military standards for traversing uneven topography by foot or wheeled vehicle.

RESULTS: Four flights were performed. Data are given as mean (± standard deviation). Time from launch to delivery was 20.77 ± 0.05 minutes (cruise speed, 34.03 ± 0.15 km/h; mean range, 12.27 ± 0.07 km). Medical supplies were delivered successfully within 1m of the target. The drone successfully returned to the starting point every flight. Resupply by foot would take 5.1 hours with an average speed of 2.4km/h and 61.35 minutes, with an average speed of 12 km/h for a wheeled vehicle, if a rudimentary road existed.

CONCLUSION: Use of unmanned drones is feasible for delivery of life-saving medical supplies in austere environments. Drones repeatedly and accurately delivered medical supplies faster than other methods without additional risk to personnel or manned airframe. This technology may have benefit for austere care of military and civilian casualties.

J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S191-S196

# Lifesaving interventions in blackout conditions using night vision technology: Come to the dark side.

Derickson M, Kuckelman J, Phillips C, Barron M, Marko S, Eckert M, Martin M, Cuadrado D

BACKGROUND: During military combat operations and civilian night-time aeromedical transport, medical providers are frequently required to perform lifesaving interventions (LSIs) in low-light environments. Because definitive surgical care is often delayed until a white light environment is permissible, we sought to determine if night optical device (NOD) technology could enable surgical capabilities in blackout conditions.

METHODS: Using a crossover design, six surgeons performed 11 different procedures on six swine, three in normal light conditions (LC) and 3 in blackout conditions (BC) using two-chamber NODs after familiarization with the procedures in both conditions on manikins. Successful completion and procedural times were compared between groups.

RESULTS: Blackout conditions were confirmed with ambient light reading of 0.2 lux during BC versus 3962.9 lux for LC (p < 0.001). There were no significant differences in success rates for any procedure. There were no differences in operative times between BC and LC for extremity tourniquet placement, femoral artery cut-down and clamping, resuscitative thoracotomy, or percutaneous resuscitative endovascular balloon occlusion of the aorta placement. The following procedures took significantly longer in BC vs. LC: Focused Assessment with Sonography for Trauma examination (98 seconds vs. 62 seconds), peripheral IV placement (140 seconds vs. 35 seconds), intraosseous access (51 seconds vs. 26 seconds), jugular vein cut-down and access (237 seconds vs. 104 seconds), laparotomy and packing (71 seconds vs. 51 seconds), stapled splenectomy (137 seconds vs. 74 seconds), resuscitative endovascular balloon occlusion of the aorta placement via cutdown (1,008 seconds vs. 338 seconds), and cricothyroidotomy (177 seconds vs. 109 seconds) (all p < 0.05).

CONCLUSION: Lifesaving interventions can be safely and effectively performed in blackout conditions using NODs, although increased difficulty with select procedure types was identified. Focused training and technological improvements to currently available devices are needed.

LEVEL OF EVIDENCE: Basic science.

Disaster Med Public Health Prep. 2019 Jul 24:1-5

# Active Shooter: What Would Health Care Students Do While Caring for Their Patients? Run? Hide? Or Fight?

McKenzie N, Wishner C, Sexton M, Saevig D, Fink B, Rega P

ABSTRACT Objective:The aim of this study was to explore the clinical decisions that health care students would make if faced with an active shooter event while providing patient care.

METHODS: A cross-sectional study design was used to survey 245 students from 6 different professional programs. Participants read 4 case-based scenarios, selected 1 of 4 actions in a multiple-choice format, and responded to an open-ended question. Demographic questions asked whether participants had been a victim of violence and whether they have taken a certified active shooter course. Statistical analysis included descriptive statistics and chi-square testing.

RESULTS: For each case, most students chose "patient-centric" versus" provider-centric" actions (range: 66%-94% and 4%-17%, respectively). The gender of the patient made no difference in actions. Those who attended a certified active shooter course tended to act with more "provider-centric" concerns than those who did not take such a course.

CONCLUSION: A significant majority of interprofessional health care students, when presented with specific case-scenarios, declared they would act to protect themselves and their patients during an active shooter event. This "patient-centric" attitude transcends the oversimplified "Run-Hide-Fight" axiom and must be addressed by all health care educational institutions.

Acta Anaesthesiol Scand. 2019 Sep 10;Epub ahead of print

# How near is near infrared spectroscopy in pre-hospital care?

Skrifvars M, Aneman A

NO ABSTRACT AVAILABLE