A Conceptual Framework for Non-Military Investigators to Understand the Joint Roles of Medical Care in the Setting of Future Large Scale Combat Operations

Schauer, Steven G; Long, Brit; Rizzo, Julie A; Walrath, Benjamin; Baker, Jeffrey R.; Gillespie, Kevin R; April, Michael D.

doi:10.1080/10903127.2021.2008070

Cited by 18 publications

(14 citation statements)

References 18 publications

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“…The FHR form is created by the military doctor who cares for the wounded soldier in the field or at role 1. Role 1 is the advanced medical post where first aid is administered by medical and paramedical personnel, as close as possible to the combat zone 6. It is part of the prehospital echelon.…”

Section: Methodsmentioning

confidence: 99%

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

Pinna

Aigle

et al. 2023

BMJ Mil Health

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IntroductionSince 2013, the French Army Health Service, in agreement with international experts, has recommended the administration of 1 g of tranexamic acid (TXA) in trauma patients in haemorrhagic shock or at risk of bleeding within 3 hours of the trauma.MethodsThe aim of this analysis was to describe the administration of TXA in French military personnel wounded during military operations in the Sahelo-Sahelian band between October 2016 and September 2020. Data were collected from forward health records and hospital data from the French hospital where the casualty was finally evacuated. Underuse of TXA was defined as the lack of administration in casualties who had received a blood transfusion with one or more of red blood cells, low-titre whole blood or French lyophilised plasma within the first 24 hours of injury and overuse as its administration in the non-transfused casualty.ResultsOf the 76 patients included, 75 were men with an average age of 28 years. Five patients died during their management. 19 patients received TXA (25%) and 16 patients were transfused (21%). Underuse of TXA occurred in 3 of the 16 patients (18.8%) transfused. Overuse occurred in 6 of 60 (10%) non-transfused patients.ConclusionThe analysis found an important underuse of TXA (almost 20%) and highlighted the need for optimising the prehospital clinical practice guidelines to aid prehospital medical practitioners more accurately in administering TXA to casualties that will require blood products.

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Section: Methodsmentioning

confidence: 99%

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

Pinna

Aigle

et al. 2023

BMJ Mil Health

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“…We must first force ourselves to parse the clinical management priorities and the approach into "must have" versus "nice to have." 11 As demonstrated both historically in World War II 12,13 and currently in Ukraine, 14 in a total war, we cannot assume supremacy or even superiority on the ground, in the air, or at sea. In this context, difficult and prolonged evacuations, collecting and transfusing blood between fellow service members, operating in low light conditions with intravenous anesthesia, and providing care for several days in austere surgical settings while under attack represent the reality.…”

Section: Adapting To These Realitiesmentioning

confidence: 99%

The cost of doing business in the modern world: Our readiness imperative

Cannon

Andrew

Rizzo

et al. 2023

J Trauma Acute Care Surg

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“…Warm fresh whole blood (WFWB) serves as a potential blood source in the austere setting where resupply is limited. This option will become even more important in large‐scale combat operations in which supply chains will be disrupted 21 . The use of WFWB is often referred to as a “walking blood bank” where medics use non‐injured personnel as the source for obtaining blood 22,23 .…”

Section: Introductionmentioning

confidence: 99%

A prospective assessment of the time required to obtain one unit of fresh whole blood by civilian phlebotomists and Army laboratory technicians (68 K)

et al. 2023

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Background Resuscitation with blood products improves survival after major hemorrhage. Blood product administration at or near the point‐of‐injury (POI) amplifies this benefit. Size, weight, and cold‐chain management challenges all limit the amount of blood medics can carry. Warm fresh whole blood (WFWB) transfusions from a pre‐screened donor within the unit represent an alternative source of blood at the POI. We measured the time required for civilian and Army technicians performing phlebotomy frequently to obtain one unit of blood to serve as a goal metric for combat medics being trained in this skill. Methods We gathered demographic and experience data along with proportion of first intravenous cannulation attempt success, time to blood flow initiated, and time to unit draw complete. Results We prospectively enrolled 12 civilian phlebotomy technicians and 10 Army laboratory technicians performing whole blood collections on 50 and 68 donors respectively. The mean time from setup to needle insertion was 3.7 min for civilians versus 4.2 min for Army technicians. The mean time from blood flowing to the bag being full was 10.7 min versus 8.4 min for civilians versus Army technicians respectively. The mean bag weights were 514 g versus 522 g. First‐pass intravenous cannulation success was 96% versus 98% respectively. Conclusions We found a high first intravenous cannulation attempt success among both the civilian and Army technicians. Medians times were <5 min to obtain venipuncture and <11 min to obtain one unit. These findings provide time‐based benchmarks for potential use during transfusion training among military medics.

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A Conceptual Framework for Non-Military Investigators to Understand the Joint Roles of Medical Care in the Setting of Future Large Scale Combat Operations

Cited by 18 publications

References 18 publications

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

Retrospective analysis of tranexamic acid administration in French war-wounded between October 2016 and September 2020

The cost of doing business in the modern world: Our readiness imperative

A prospective assessment of the time required to obtain one unit of fresh whole blood by civilian phlebotomists and Army laboratory technicians (68 K)

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