Casualty care implications of large-scale combat operations

Remondelli, Mason H; Remick, Kyle N.; Shackelford, Stacy; Gurney, Jennifer M; Pamplin, Jeremy; Polk, Travis M.; Potter, Benjamin K.; Holt, Danielle B.

doi:10.1097/ta.0000000000004063

Cited by 33 publications

(8 citation statements)

References 21 publications

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“…These findings highlight a potential discrepancy between established transfusion and storage practices and the true needs of casualties in combat trauma scenarios. It is essential to consider multifactorial strategies which centralize on prompt and effective casualty assessment and the prioritization of patients with the highest likelihood of surviving initial damage control resuscitation and damage control surgery 21 . Moreover, an emphasis on maintaining a sufficient supply of whole blood and blood products as well as establishing more robust methods for resupply should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Explosives were the predominant mechanism of injury among both groups. The composite injury severity score was 5 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) in non-recipients and 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) in recipients. Among the blood recipients, there was a higher proportion of serious injuries to all body regions.…”

Section: All Casualtiesmentioning

confidence: 99%

“…It is essential to consider multifactorial strategies which centralize on prompt and effective casualty assessment and the prioritization of patients with the highest likelihood of surviving initial damage control resuscitation and damage control surgery. 21 Moreover, an emphasis on maintaining a sufficient supply of whole blood and blood products as well as establishing more robust methods for resupply should be considered. Conversely, we need strategies to identify those that are unsalvageable.…”

Section: Us Military Coalition Us Contractors Onlymentioning

confidence: 99%

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Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

McWhirter,

April,

Fisher

et al. 2024

Transfusion

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BackgroundThe Role 2 setting represents the most far‐forward military treatment facility with limited surgical and holding capabilities. There are limited data to guide recommendations on blood product utilization at the Role 2. We describe the consumption of blood products in this setting.Study Design and MethodsWe analyzed data from 2007 to 2023 from the Department of Defense Trauma Registry (DODTR) that received care at a Role 2. We used descriptive and inferential statistics to characterize the volumes of blood products consumed in this setting. We also performed a secondary analysis of US military, Coalition, and US contractor personnel.ResultsWithin our initial cohort analysis of 15,581 encounters, 17% (2636) received at least one unit of PRBCs or whole blood, of which 11% received a submassive transfusion, 4% received a massive transfusion, and 1% received a supermassive transfusion. There were 6402 encounters that met inclusion for our secondary analysis. With this group, 5% received a submassive transfusion, 2% received a massive transfusion, and 1% received a supermassive transfusion.ConclusionsWe described volumes of blood products consumed at the Role 2 during recent conflicts. The maximum number of units consumed among survivors exceeds currently recommended available blood supply. Our findings suggest that rapid resupply and cold‐stored chain demands may be higher than anticipated in future conflicts.

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Section: Discussionmentioning

confidence: 99%

Section: All Casualtiesmentioning

confidence: 99%

Section: Us Military Coalition Us Contractors Onlymentioning

confidence: 99%

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Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

McWhirter,

April,

Fisher

et al. 2024

Transfusion

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“…In this scenario, civilian hospitals can collaborate and assist as many victims as possible. Combat Casualty Care (CCC) [26 ▪▪ ] is a concept that came from the experience of treating injured patients during conflict and involves life-saving damage control resuscitation and surgery. Many times, this results in surgeons weighing the risk-benefit of saving lives versus saving limbs.…”

Section: Civilian Supportmentioning

confidence: 99%

Disaster management – preparation and planning for acute care facilities

Gandra d’Almeida,

Coopersmith

2024

Current Opinion in Critical Care

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Purpose of review Both human-derived and naturally-occurring disasters stress the surge capacity of health systems and acute care facilities. In this article, we review recent literature related to having a disaster plan, facility planning principles, institutional and team preparedness, the concept of surge capacity, simulation exercises and advantages and disadvantages of each. Recent findings Evidence suggests that every institution should have a disaster plan and a dedicated team responsible for updating this plan. The disaster plan must be people-oriented and incorporate different perspectives and opinions so that all stakeholders feel included and can contribute to a joint response. Simulation exercises are fundamental for preparation so that the team functions seamlessly in uncommon times when disaster management transitions from a theoretical plan to one that is executed in real time. Notably, however, there are significantly different realities related to disaster management between countries and even within the same country or region. Unfortunately, key stakeholders such as hospital administration, board of directors and investors often do not believe they have any responsibility related to disaster management planning or response. Additionally, while a disaster plan often exists within an institution, it is frequently not well known or understood by many stakeholders. Communication, simple plans and well defined roles are some of the most important characteristics of a successful response. In extreme circumstances, adapting civilian facilities to manage high-volume warfare-related injuries may be adopted, but the consequences of this approach for routine healthcare within a system can be devastating. Summary Disaster management requires careful planning with input from multiple stakeholders and a plan that is frequently updated with repeated preparation to ensure the team is ready when a disaster occurs. Close communication as well as clearly defined roles are critical to success when transitioning from preparation to activation and execution of a disaster response.

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“…Various kinds of gunshot injuries are common in armed conflicts and warfare, causing severe trauma both to the military personnel and the civilian population [ 1 ]. A war of Russia against Ukraine was initiated in 2014 as a hybrid warfare, and an active invasion phase has been ongoing since February 24, 2022.…”

Section: Introductionmentioning

confidence: 99%

A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war

Tertyshnyi,

Lurin,

Khomenko

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Gunshot injury to the hand is severe trauma, requiring complicated reconstruction surgery for the damaged anatomic site to restore all the hand functions. The aim of this study was to show the example of the distal phalanx reconstruction by using a flap with distal transverse digital artery (DTDA) blood supply as well as to demonstrate the utility of the audio Doppler application at the reconstruction stage in the combat patient injured in the Russo-Ukrainian war. Case presentation In this report, we present a case of a 26-year-old service member of the Ukrainian Armed Forces delivered to the Military Medical Clinical Centre on the fourth day after the gunshot gutter shrapnel wound of the distal flexor of the 2nd digit with a gunshot fracture of the ungula (distal) and middle phalanges of the 2nd digit of the right hand along with a bone deficiency of the osseous structure of the distal and middle phalanges, volar soft tissues. The dorsal metacarpal artery (DMCA) flap is a universal variant among the tools of the reconstructive plastic surgeon engaged in reconstructing defects of the digital dorsum and flexors with a limited range of flaps. We consider this to be a key that conforms with the majority of the reconstructive principles, such as ‘analog replacement’, and which is simple, adequate, and easy for operating with a minimal sequela of the donor site. Conclusions The distal transverse digital artery (DTDA) could be considered for hand reconstructive surgery for repairing defects of the flexor surface of the digit injury and hands after severe gunshot injury.

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Casualty care implications of large-scale combat operations

Cited by 33 publications

References 21 publications

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

Blood consumption in the Role 2 setting: A Department of Defense Trauma Registry analysis

Disaster management – preparation and planning for acute care facilities

A new approach for reconstruction of the gunshot defect of the flexor surface of the ungual (distal) phalanx by the proper transverse branch of the digital artery: a case report of combat patient injured in the Russo-Ukrainian war

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