EMERGENCY LIFE-SAVING CRANIAL PROCEDURES BY NON-NEUROSURGEONS IN DEPLOYED SETTING

Summary of Changes

1. Updated literature reference list to reflect current evidence for the following:
   - Superior patient outcomes when neurosurgeons are directly deployed to combat area of responsibility.
   - Committee of Surgical Combat Casualty Care position statement reinforcing optimal patient management requires the deployed neurosurgeon for management of severe Traumatic Brain Injury (TBI).
   - Superior patient outcomes with ultra-early surgical intervention for severe TBI.
2. Added two new ‘synchronous’ neurosurgical support tele-capabilities, including Advanced Virtual Support for Operational Forces and Navy Medicine Readiness and Training Command San Diego on-call neurosurgeon.
3. Provided a streamlined algorithm for clinical indications supporting cranial surgical intervention.
4. Provided clarifying radiographic information and CPG reference (Catastrophic Non-Survivable Brain Injury) for when NOT to perform a cranial procedure.
5. Expanded procedural check-list for both penetrating and non-penetrating cranial injury.