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Schauer SG, Mendez J, Uhaa N, Hudson IL, Weymouth WL. A Prospective, Feasibility Assessment of a Novel, Disposable Video Laryngoscope With Special Operations Medical Personnel in a Mobile Helicopter Simulation Setting. JOURNAL OF SPECIAL OPERATIONS MEDICINE : A PEER REVIEWED JOURNAL FOR SOF MEDICAL PROFESSIONALS 2022; 21:26-29. [PMID: 34969123 DOI: 10.55460/581v-swp2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Video laryngoscopy (VL) is shown to improve first-pass success rates and decrease complications in intubations, especially in novice proceduralists. However, the currently fielded VL devices are cost-prohibitive for dispersion across the battlespace. The novel i-view VL is a low-cost, disposable VL device that may serve as a potential solution. We sought to perform end-user performance testing and solicit feedback. METHODS We prospectively enrolled Special Operations flight medics with the 160th Special Operations Aviation Regiment at Hunter Army Airfield, Savannah, Georgia. We asked them to perform an intubation using a synthetic cadaver model while in a mobile helicopter simulation setting. We surveyed their feedback afterward. RESULTS The median age of participants was 30 and all were male. Of those, 60% reported previous combat deployments, with a median of 20 months of deployment time. Of the 10, 90% were successful with intubation, with 60% on first-pass success with an average of 83 seconds time to intubation. Most had a grade 1 view. Most agreed or strongly agreed that it was easy to use (70%), with half (50%) reporting they would use it in the deployed setting. Several made comments about the screen not being bright enough and would prefer one with a rotating display. CONCLUSIONS We found a high proportion of success for intubation in the mobile simulator and a high satisfaction rate for this device by Special Operations Forces medics.
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Beaman HT, Shepherd E, Satalin J, Blair S, Ramcharran H, Serinelli S, Gitto L, Dong KS, Fikhman D, Nieman G, Schauer SG, Monroe MBB. Hemostatic shape memory polymer foams with improved survival in a lethal traumatic hemorrhage model. Acta Biomater 2022; 137:112-123. [PMID: 34655799 DOI: 10.1016/j.actbio.2021.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/01/2022]
Abstract
Although there are many hemostatic agents available for use on the battlefield, uncontrolled hemorrhage is still the primary cause of preventable death. Current hemostatic dressings include QuikClot® Combat Gauze (QCCG) and XStat®, which have inadequate success in reducing mortality. To address this need, a new hemostatic material was developed using shape memory polymer (SMP) foams, which demonstrate biocompatibility, rapid clotting, and shape recovery to fill the wound site. SMP foam hemostatic efficacy was examined in a lethal, noncompressible porcine liver injury model over 6 h following injury. Wounds were packed with SMP foams, XStat, or QCCG and compared in terms of time to bleeding cessation, total blood loss, and animal survival. The hemostatic material properties and in vitro blood interactions were also characterized. SMP foams decreased blood loss and active bleeding time in comparison with XStat and QCCG. Most importantly, SMP foams increased the 6 h survival rate by 50% and 37% (vs. XStat and QCCG, respectively) with significant increases in survival times. Based upon in vitro characterizations, this result is attributed to the low stiffness and shape filling capabilities of SMP foams. This study demonstrates that SMP foams have promise for improving upon current clinically available hemostatic dressings and that hemostatic material properties are important to consider in designing devices for noncompressible bleeding control. STATEMENT OF SIGNIFICANCE: Uncontrolled hemorrhage is the leading cause of preventable death on the battlefield, and it accounts for approximately 1.5 million deaths each year. New biomaterials are required for improved hemorrhage control, particularly in noncompressible wounds in the torso. Here, we compared shape memory polymer (SMP) foams with two clinical dressings, QuikClot Combat Gauze and XStat, in a pig model of lethal liver injury. SMP foam treatment reduced bleeding times and blood loss and significantly improved animal survival. After further material characterization, we determined that the improved outcomes with SMP foams are likely due to their low stiffness and controlled shape change after implantation, which enabled their delivery to the liver injuries without inducing further wound tearing. Overall, SMP foams provide a promising option for hemorrhage control.
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Yauger YJ, Beaumont DM, Brady K, Schauer SG, O'Sullivan J, Hensler JG, Johnson D. Endotracheal Administered Epinephrine Is Effective in Return of Spontaneous Circulation Within a Pediatric Swine Hypovolemic Cardiac Arrest Model. Pediatr Emerg Care 2022; 38:e187-e192. [PMID: 32701868 DOI: 10.1097/pec.0000000000002208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Early administration of epinephrine increases the incidence of return of spontaneous circulation (ROSC) and improves outcomes among pediatric cardiac arrest victims. Rapid endotracheal (ET) intubation can facilitate early administration of epinephrine to pediatric victims. To date, no studies have evaluated the use of ET epinephrine in a pediatric hypovolemic cardiac arrest model to determine the incidence of ROSC. METHODS This prospective, experimental study evaluated the pharmacokinetics and/or incidence of ROSC following ET administered epinephrine and compared it to these experimental groups: intravenous (IV) administered epinephrine, cardiopulmonary resuscitation only (CPR), and CPR + defibrillation (CPR + Defib). RESULTS Endotracheal administered epinephrine, at the Pediatric Advanced Life Support (PALS) recommended dose, was not significantly different than IV administered epinephrine in maximum plasma concentrations, time to maximum plasma concentration, area under the curve, or ROSC, or mean plasma concentrations at various time points (P > 0.05). The odds of ROSC in the ET group were 2.4 times greater than the IV group. The onset to ROSC in the ET group was significantly shorter than the IV group (P < 0.0001). CONCLUSIONS These data support that ET epinephrine administration remains an alternative to IV administered epinephrine and faster at restoring ROSC among pediatric hypovolemic cardiac arrest victims in the acute setting when an endotracheal tube is present. Although further research is required to determine long-term outcomes of high-dose ET epinephrine administration, these data reinforce the therapeutic potential of ET administration of epinephrine to restore ROSC before IV access.
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Clarke EE, Hamm J, Fisher AD, April MD, Long BJ, Mdaki KS, Hill R, Bynum JA, Schauer SG. Trends in Prehospital Blood, Crystalloid, and Colloid Administration in Accordance With Changes in Tactical Combat Casualty Care Guidelines. Mil Med 2021; 187:e1265-e1270. [PMID: 34935982 DOI: 10.1093/milmed/usab461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Hemorrhage is the leading threat to the survival of battlefield casualties. This study aims to investigate the types of fluids and blood products administered in prehospital trauma encounters to discover the effectiveness of Tactical Combat Casualty Care (TCCC) recommendations. MATERIALS AND METHODS This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry with a focus on prehospital fluid and blood administration in conjunction with changes in the TCCC guidelines. We collected demographic information on each patient. We categorized receipt of each fluid type and blood product as a binary variable for each casualty and evaluated trends over 2007-2020 both unadjusted and controlling for injury severity and mechanism of injury. RESULTS Our original dataset comprised 25,897 adult casualties from January 1, 2007 through March 17, 2020. Most (97.3%) of the casualties were male with a median age of 25. Most (95.5%) survived to hospital discharge, and 12.2% of the dataset received fluids of any kind. Medical personnel used crystalloids in 7.4% of encounters, packed red blood cells in 2.0%, and whole blood in 0.5% with very few receiving platelets or freeze-dried plasma. In the adjusted model, we noted significant year-to-year increases in intravenous fluid administration from 2014 to 2015 and 2018 to 2019, with significant decreases noted in 2008-2009, 2010-2012, and 2015-2016. We noted no significant increases in Hextend used, but we did note significant decreases in 2010-2012. For any blood product, we noted significant increases from 2016 to 2017, with decreases noted in 2009-2013, 2015-2016, and 2017-2018. Overall, we noted a general spike in all uses in 2011-2012 that rapidly dropped off 2012-2013. Crystalloids consistently outpaced the use of blood products. We noted a small upward trend in all blood products from 2017 to 2019. CONCLUSIONS Changes in TCCC guidelines did not immediately translate into changes in prehospital fluid administration practices. Crystalloid fluids continue to dominate as the most commonly administered fluid even after the 2014 TCCC guidelines changed to use of blood products over crystalloids. There should be future studies to investigate the reasons for delay in guideline implementation and efforts to improve adherence.
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Bebarta GE, Bebarta VS, Fisher AD, April MD, Atkinson AJ, McGhee LL, Schauer SG. An Analysis of Ketamine Doses Administrated to Nonintubated Casualties Prehospital. Mil Med 2021; 188:usab511. [PMID: 34865120 DOI: 10.1093/milmed/usab511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Previous studies demonstrate that a significant proportion of casualties do not receive pain medication prehospital after traumatic injuries. To address possible reasons, the U.S. Military has sought to develop novel delivery methods to aid in administration of pain medications prehospital. We sought to describe the dose and route of ketamine administered prehospital to help inform materiel solutions. MATERIALS AND METHODS This is a secondary analysis of a previously described dataset focused on prehospital data within the Department of Defense Trauma Registry from 2007 to 2020. We isolated encounters in which ketamine was administered along with the amount dosed and the route of administration in nonintubated patients. RESULTS Within our dataset, 862 casualties met inclusion for this analysis. The median age was 28 and nearly all (98%) were male. Most were battle injuries (88%) caused by explosives (54%). The median injury severity score was 10 with the extremities accounting to the most frequent seriously injured body region (38%). The mean dose via intravenous route was 50.4 mg (n = 743, 95% CI 46.5-54.3), intramuscular was 66.7 mg (n = 234, 95% CI 60.3-73.1), intranasal was 56.5 mg (n = 10, 39.1-73.8), and intraosseous was 83.3 mg (n = 34, 66.3-100.4). Most had a medic or CLS in their chain of care (87%) with air evacuation as the primary mechanism of evacuation (86%). CONCLUSIONS The average doses administered were generally larger than the doses recommended by Tactical Combat Casualty Care guidelines. Currently, guidelines may underdose analgesia. Our data will help inform materiel solutions based on end-user requirements.
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Yoo MJ, Schauer SG, Trueblood WE. 'Swab and Go' impact on emergency department left without being seen rates. Am J Emerg Med 2021; 57:164-165. [PMID: 34893401 PMCID: PMC8639291 DOI: 10.1016/j.ajem.2021.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022] Open
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Dylla L, Douin DJ, Anderson EL, Rice JD, Jackson CL, Bebarta VS, Lindsell CJ, Cheng AC, Schauer SG, Ginde AA. A multicenter cluster randomized, stepped wedge implementation trial for targeted normoxia in critically ill trauma patients: study protocol and statistical analysis plan for the Strategy to Avoid Excessive Oxygen (SAVE-O2) trial. Trials 2021; 22:784. [PMID: 34749762 PMCID: PMC8574946 DOI: 10.1186/s13063-021-05688-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Targeted normoxia (SpO2 90–96% or PaO2 60–100 mmHg) may help to conserve oxygen and improve outcomes in critically ill patients by avoiding potentially harmful hyperoxia. However, the role of normoxia for critically ill trauma patients remains uncertain. The objective of this study is to describe the study protocol and statistical analysis plan for the Strategy to Avoid Excessive Oxygen for Critically Ill Trauma Patients (SAVE-O2) clinical trial. Methods Design, setting, and participants: Protocol for a multicenter cluster randomized, stepped wedge implementation trial evaluating the effectiveness of a multimodal intervention to target normoxia in critically ill trauma patients at eight level 1 trauma centers in the USA. Each hospital will contribute pre-implementation (control) and post-implementation (intervention) data. All sites will begin in the control phase with usual care. When sites reach their randomly assigned time to transition, there will be a one-month training period, which does not contribute to data collection. Following the 1-month training period, the site will remain in the intervention phase for the duration of the trial. Main outcome measures: The primary outcome will be supplemental oxygen-free days, defined as the number of days alive and not on supplemental oxygen. Secondary outcomes include in-hospital mortality to day 90, hospital-free days to day 90, ventilator-free days (VFD) to day 28, time to room air, Glasgow Outcome Score (GOS), and duration of time receiving supplemental oxygen. Discussion SAVE-O2 will determine if a multimodal intervention to improve compliance with targeted normoxia will safely reduce the need for concentrated oxygen for critically injured trauma patients. These data will inform military stakeholders regarding oxygen requirements for critically injured warfighters, while reducing logistical burden in prolonged combat casualty care. Trial registration ClinicalTrials.govNCT04534959. Registered September 1, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05688-6.
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Fisher AD, Lavender JS, April MD, Hill R, Bynum J, Schauer SG. A Descriptive Analysis of Supermassive Transfusion Recipients Among US and Coalition Forces During Combat Operations in Afghanistan and Iraq. Mil Med 2021; 188:e1022-e1027. [PMID: 34741519 DOI: 10.1093/milmed/usab455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/09/2021] [Accepted: 10/20/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Hemorrhage is the leading cause of potentially preventable death on the battlefield. Resuscitation with blood products is essential to restore circulating volume, repay the oxygen debt, and prevent coagulopathy. Massive transfusion (MT) occurs frequently after major trauma; a subset of casualties requires a supermassive transfusion (SMT), and thus, mobilization of additional resources remains unclear. MATERIALS AND METHODS This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. In this analysis, we isolated U.S. and Coalition casualties that received at least 1 unit of packed red blood cells (PRBCs) or whole blood (WB). Given a lack of consensus on the definition of SMT recipients, we included those patients receiving the top quartile of PRBC and WB administered within the first 24 hours following arrival to a military treatment facility. RESULTS We identified 25,897 adult casualties from January 1, 2007 to March 17, 2020. Within this dataset, 2,608 (9.0%) met inclusion for this analysis. The median number of total products administered within the first 24 hours was 8 units of PRBC or WB. The upper quartile was 18 units (n = 666). Compared to all other blood product recipients, patients in the SMT cohort had a higher median injury severity score (27 vs 18, P < 0.001), were most frequently injured by explosives (84.9% vs 68.6%, P < 0.001), had a higher mean emergency department (ED) pulse (128 vs 111, P < 0.001), a lower mean systolic blood pressure (122 vs 132 mm Hg, P < 0.001), and a higher mean international normalized ratio (1.68 vs 1.38, P < 0.001). SMT patients experienced lower survival to hospital discharge (85.8% vs 93.3%, P < 0.001). CONCLUSIONS Compared to all other PRBC and WB recipients, SMT patients experienced more injury by explosives, severe injury patterns, ED vital sign derangements, and mortality. These findings may help identify those casualties who may require earlier aggressive resuscitation. However, more data is needed to define this population early in their clinical course for early identification to facilitate rapid resource mobilization. Identifying casualties who are likely to die within 24 hours compared to those who are likely to survive, may assist in determining a threshold for a SMT.
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Fisher AD, April MD, Naylor JF, Kotwal RS, Schauer SG. The Battalion Aid Station-The Forgotten Frontier of the Army Health System During the Global War on Terrorism. Mil Med 2021; 188:e1240-e1245. [PMID: 34651651 DOI: 10.1093/milmed/usab401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The battalion aid station (BAS) has historically served as the first stop during which combat casualties would receive care beyond a combat medic. Since the conflicts in Iraq and Afghanistan, many combat casualties have bypassed the BAS for treatment facilities capable of surgery. We describe the care provided at these treatment facilities during 2007-2020. METHODS This is a secondary analysis of previously described data from the Department of Defense Trauma Registry. We included encounters with the documentation of an assessment or intervention at a BAS or forward operating base from January 1, 2007 to March 17, 2020. We utilized descriptive statistics to characterize these encounters. RESULTS There were 28,950 encounters in our original dataset, of which 3.1% (884) had the documentation of a prehospital visit to a BAS. The BAS cohort was older (25 vs. 24, P < .001) The non-BAS cohort saw a larger portion of pediatric (<18 years) patients (10.7% vs. 5.7%, P < .001). A higher proportion of BAS patients had nonbattle injuries (40% vs. 20.7%, P < .001). The mean injury severity score was higher in the non-BAS cohort (9 vs. 5, P < .001). A higher proportion of the non-BAS cohort had more serious extremity injuries (25.1% vs. 18.4%, P < .001), although the non-BAS cohort had a trend toward serious injuries to the abdomen (P = .051) and thorax (P = .069). There was no difference in survival. CONCLUSIONS The BAS was once a critical point in casualty evacuation and treatment. Within our dataset, the overall number of encounters that involved a stop at a BAS facility was low. For both the asymmetric battlefield and multidomain operations/large-scale combat operations, the current model would benefit from a more robust capability to include storage of blood, ventilators, and monitoring and hold patients for an undetermined amount of time.
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Schauer SG, Naylor JF, April MD, Carius BM, Hudson IL. Analysis of the Effects of COVID-19 Mask Mandates on Hospital Resource Consumption and Mortality at the County Level. South Med J 2021; 114:597-602. [PMID: 34480194 PMCID: PMC8395971 DOI: 10.14423/smj.0000000000001294] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 has continued to spread despite measures put in place to help slow the spread. It remains unclear which measures are effective. Data guiding policymakers on efficacy will help focus efforts. We found that mask orders were ineffective in slowing the spread of coronavirus disease 2019 at the county level. Supplemental digital content is available in the text. Coronavirus disease 2019 (COVID-19) threatens vulnerable patient populations, resulting in immense pressures at the local, regional, national, and international levels to contain the virus. Laboratory-based studies demonstrate that masks may offer benefit in reducing the spread of droplet-based illnesses, but few data are available to assess mask effects via executive order on a population basis. We assess the effects of a county-wide mask order on per-population mortality, intensive care unit (ICU) utilization, and ventilator utilization in Bexar County, Texas.
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Long A, Fillinger M, April MD, Hudson IL, Trueblood W, Schmitz G, Chin EJ, Hartstein B, Pfaff JA, Schauer SG. Changes in Emergency Department Volumes at the Largest U.S. Military Hospital During the COVID-19 Pandemic. Mil Med 2021; 187:e1456-e1461. [PMID: 34411255 DOI: 10.1093/milmed/usab322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The coronavirus-2019 (COVID-19) pandemic has significantly impacted global healthcare delivery. Brooke Army Medical Center (BAMC) is the DoD's largest hospital and a critical platform for maintaining a ready medical force. We compare temporal trends in patient volumes and characteristics in the BAMC emergency department (ED) before versus during the pandemic. MATERIALS AND METHODS We abstracted data on patient visits from the BAMC ED electronic medical record system. Data included patient demographics, visit dates, emergency severity index triage level, and disposition. We visually compared the data from January 1, 2019 to November 30, 2019 versus January 1, 2020 to November 30, 2020 to assess the period with the most apparent differences. We then used descriptive statistics to characterize the pre-pandemic control period (1 March-November 30, 2019) versus the pandemic period (1 March-November 30, 2020). RESULTS Overall, when comparing the pre-pandemic and pandemic periods, the median number of visits per day was 232 (Interquartile Range (IQR) 214-250, range 145-293) versus 165 (144-193, range 89-308, P < .0001). Specific to pediatric visits, we found the median number of visits per day was 39 (IQR 33-46, range 15-72) versus 18 (IQR 14-22, range 5-61, P < .001). When comparing the median number of visits by month, the volumes were lower during the pandemic for all months, all of which were strongly significant (P < .001 for all). CONCLUSIONS The BAMC ED experienced a significant decrease in patient volume during the COVID-19 pandemic starting in March 2020. This may have significant implications for the capacity of this facility to maintain a medically ready force.
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Lauby RS, Cuenca CM, Borgman MA, Fisher AD, Bebarta VS, Moore EE, Spinella PC, Bynum J, Schauer SG. An analysis of outcomes for pediatric trauma warm fresh whole blood recipients in Iraq and Afghanistan. Transfusion 2021; 61 Suppl 1:S2-S7. [PMID: 34269463 DOI: 10.1111/trf.16504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/27/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Whole blood therapy-which contains the ideal balance of components, and particularly fresh whole blood-has been shown to be beneficial in adult trauma. It remains unclear whether there is potential benefit in the pediatric population. STUDY DESIGN AND METHODS This is a secondary analysis of previously published data analyzing pediatric casualties undergoing massive transfusion in the Department of Defense Trauma Registry. Pediatric patients with traumatic injury who were transfused at least one blood product were included in the analysis. We compared children who received component therapy exclusively to those who received any amount of warm fresh whole blood. RESULTS Of the 3439 pediatric casualties within our dataset, 1244 were transfused at least one blood product within the first 24 h. There were 848 patients without severe head injury. Within this cohort, 23 children received warm fresh whole blood overall, 20 of whom did not have severe head injury. In an adjusted analysis, the odds ratio (95% confidence interval [CI]) for survival for warm fresh whole blood recipients was 2.86 (0.40-20.45). After removing children with severe brain injury, there was an independent association with improved survival for warm fresh whole blood recipients with an odds ratio (95% CI) of 58.63 (2.70-1272.67). DISCUSSION Our data suggest that warm fresh whole blood may be associated with improved survival in children without severe head injury. Larger prospective studies are needed to assess the efficacy and safety of whole blood in children with severe traumatic bleeding.
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Schauer SG, April MD, Arana AA, Maddry JK, Escandon MA, Linscomb CD, Rodriguez DC, Convertino VA. Efficacy of the compensatory reserve measurement in an emergency department trauma population. Transfusion 2021; 61 Suppl 1:S174-S182. [PMID: 34269446 DOI: 10.1111/trf.16498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Compensatory Reserve Measurement (CRM) is a novel method used to provide early assessment of shock based on arterial wave form morphology changes. We hypothesized that (1) CRM would be significantly lower in those trauma patients who received life-saving interventions compared with those not receiving interventions, and (2) CRM in patients who received interventions would recover after the intervention was performed. STUDY DESIGN AND METHODS We captured vital signs along with analog arterial waveform data from trauma patients meeting major activation criteria using a prospective study design. Study team members tracked interventions throughout their emergency department stay. RESULTS Ninety subjects met inclusion with 13 receiving a blood product and 10 a major airway intervention. Most trauma was blunt (69%) with motor vehicle collisions making up the largest proportion (37%) of injury mechanism. Patients receiving blood products had lower CRM values just prior to administration versus those who did not (50% versus 58%, p = .045), and lower systolic pressure (SBP; 95 versus 123 mmHg, p = .005), diastolic (DBP; 62 versus 79, p = .007), and mean arterial pressure (MAP; 75 versus 95, p = .006), and a higher pulse rate (HR; 101 versus 89 bpm, p = .039). Patients receiving an airway intervention had lower CRM values just prior to administration versus those who did not (48% versus 58%, p = .062); however, SBP, DBP, MAP, and HR were not statistically distinguishable (p ≥ .645). CONCLUSIONS Our results support our hypotheses that the CRM distinguished those patients who received blood or an airway intervention from those who did not, and increased appropriately after interventions were performed.
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Dylla L, Anderson EL, Douin DJ, Jackson CL, Rice JD, Schauer SG, Neumann RT, Bebarta VS, Wright FL, Ginde AA. A quasiexperimental study of targeted normoxia in critically ill trauma patients. J Trauma Acute Care Surg 2021; 91:S169-S175. [PMID: 33797494 PMCID: PMC9709909 DOI: 10.1097/ta.0000000000003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Avoidance of hypoxia and hyperoxia may reduce morbidity and mortality in critically ill civilian and military trauma patients. The objective of this study was to determine if a multimodal quality improvement intervention increases adherence to a consensus-based, targeted normoxia strategy. We hypothesized that this intervention would safely improve compliance with targeted normoxia. METHODS This is a pre/postquasiexperimental pilot study to improve adherence to normoxia, defined as a pulse oximetry (SpO2) of 90% to 96% or an arterial partial pressure oxygen (PaO2) of 60 to 100 mm Hg. We used a multimodal informatics and educational intervention guiding clinicians to safely titrate supplemental oxygen to normoxia based on SpO2 monitoring in critically ill trauma patients admitted to the surgical-trauma or neurosurgical intensive care unit within 24 hours of emergency department arrival. The primary outcome was effectiveness in delivering targeted normoxia (i.e., an increase in the probability of being in the targeted normoxia range and/or a reduction in the probability of being on a higher fraction-inspired oxygen concentration [FiO2]). RESULTS Analysis included 371 preintervention subjects and 201 postintervention subjects. Preintervention and postintervention subjects were of similar age, race/ethnicity, and sex and had similar comorbidities and Acute Physiologic and Chronic Health Evaluation II scores. Overall, the adjusted probability of being hyperoxic while on supplemental oxygen was reduced during the postintervention period (adjusted odds ratio, 0.74; 95% confidence interval, 0.57-0.97). There was a higher probability of being on room air (FiO2, 0.21) in the postintervention period (adjusted odds ratio, 1.38; 95% confidence interval, 0.83-2.30). In addition, there was a decreased amount of patient time spent on higher levels of FiO2 (FiO2, >40%) without a concomitant increase in hypoxia. CONCLUSION A multimodal intervention targeting normoxia in critically ill trauma patients increased normoxia and lowered the use of supplemental oxygen. A large clinical trial is needed to validate the impact of this protocol on patient-centered clinical outcomes. LEVEL OF EVIDENCE Therapeutic/care management, level II.
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Sam AE, Hamele MT, Matos RI, Fagiana AM, Borgman MA, Maddry JK, Schauer SG. A Descriptive Analysis of Pediatric Transports Throughout the U.S. Indo-Pacific Command. Mil Med 2021; 186:e743-e748. [PMID: 33216936 PMCID: PMC8246610 DOI: 10.1093/milmed/usaa506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 12/03/2022] Open
Abstract
Background The U.S. Indo-Pacific Command (INDOPACOM) has over 375,000 military personnel, civilian employees, and their dependents. Routine pediatric care is available in theater, but pediatric subspecialty, surgical, and intensive care often require patient movement. Transfer is frequently performed by military air evacuation teams and intermittently augmented by civilian services. Pediatric care requires special training and equipment, yet most transports are staffed by non-pediatric specialists. We seek to describe the epidemiology of pediatric transport missions in INDOPACOM. Methods A retrospective review of all patients less than 18 years old transported within INDOPACOM and logged into the Transportation Command Regulating and Command and Control Evacuation System (TRAC2ES) database from June 2008 through June 2018 was conducted. Data are reported using descriptive statistics. Patients were categorized into four age groups: neonatal (<31 days), infant (31-364 days), young children (1 to <8 years), and older children (8-17 years). Results During the study period, 687 out of 4,217 (16.3%) transports were children. Median age was 4 years (interquartile range 6 months to 8 years) and 654 patients (95.2%) were transported via military fixed-wing aircraft. There were 219 (31.9%) neonates, 162 (23.6%) infants, 133 (19.4%) young children, and 173 (25.2%) older children. Most common diagnoses encountered were respiratory, cardiac, or abdominal, although older children had a higher percentage of psychiatric diagnoses (28%). Mechanical ventilation was used in 118 (17.2%) patients, and 75 (63.6%) of these patients were neonates. Conclusions Within TRAC2ES, nearly one in six encounters were patients aged <18 years, with neonates or infants representing nearly one of three pediatric encounters. Slightly more than one in six pediatric patients required intubation for transport. The data suggest the need for appropriately trained transport teams and equipment be provided to support these missions.
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Tapia AD, Cuenca CM, Johnson SJ, Lauby RS, Bynum J, Fernandez W, Long A, Long B, Maddry JK, April MD, Chin EJ, Schauer SG. Assessing Challenges with Access to Care for Patients Presenting to the Emergency Department for Non-Emergent Complaints. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:74-80. [PMID: 34449865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Emergency department (ED) utilization continues to climb nationwide resulting in overcrowding, increasing wait times, and a surge in patients with non-urgent conditions. Patients frequently choose the ED for apparent non-emergent medical issues or injuries that after-the-fact could be cared for in a primary care setting. We seek to better understand the reasons why patients choose the ED over their primary care managers. METHODS We prospectively surveyed patients that signed into the ED at the Brooke Army Medical Center as an emergency severity index of 4 or 5 (non-emergent triage) regarding their visit. We then linked their survey data to their ED visit including interventions, diagnoses, diagnostics, and disposition by using their electronic medical record. We defined their visit to be non-urgent and more appropriate for primary care, or primary care eligible, if they were discharged home and received no computed tomography (CT) imaging, ultrasound, magnetic resonance imaging (MRI), intravenous (IV) medications, or intramuscular (IM) controlled substances. RESULTS During the 2-month period, we collected data on 208 participants out of a total of 252 people offered a survey (82.5%). There were 92% (n=191) that were primary care eligible within our respondent pool. Most reported very good (38%) or excellent (21%) health at baseline. On survey assessing why they came, inability to get a timely appointment (n=73), and a self-reported emergency (n=58) were the most common reported reasons. Most would have utilized primary care if they had a next-morning appointment available (n=86), but many reported they would have utilized the ED regardless of primary care availability (n=77). The most common suggestion for improving access to care was more primary care appointment availability (n=96). X-rays were the most frequent study (37%) followed by laboratory studies (20%). Before coming to the ED, 38% (n=78) reported trying to contact their primary care for an appointment. Before coming to the ED, 22% (n=46) reported contacting the nurse advice line. Based on our predefined model, 92% (n=191) of our respondents were primary care eligible within our respondent pool. CONCLUSIONS Patient perceptions of difficulty obtaining appointments appear to be a major component of the ED use for non-emergent visits. Within our dataset, most patients surveyed stated they had difficulty obtaining a timely appointment or self-reported as an emergency. Data suggests most patients surveyed could be managed in the primary care setting.
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Taylor DH, Wagner EM, Hu JS, Tobin MR, Cronin AJ, Couperus KS, April MD, Schauer SG, Naylor JF. New Versus Old, The i-View Video Laryngoscope Versus the GlideScope: A Prospective, Randomized, Crossover Trial. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:81-89. [PMID: 34449866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND A novel video laryngoscope device, the i-view, may extend intubation capability to the lowest echelons of deployed military medicine. The i-view is a one-time use, disposable laryngoscope. We compared time to completion of endotracheal intubation (ETI) between the i-view and GlideScope among military emergency medicine providers in a simulation setting. METHODS We conducted a prospective, randomized, crossover trial. We randomized participants to i-view or GlideScope first before they performed 2 ETI-1 with each device. The primary outcome was time to completion of ETI. Secondary outcomes included first-pass success, optimal glottic view, and end-user appraisal. We used a Laerdal Airway Management Trainer for all intubations. RESULTS Thirty-three emergency medicine providers participated. ETI time was less with GlideScope than i-view (22.2 +/- 9.0 seconds versus 30.2 +/- 24.0 seconds; p=0.048). Optimal glottic views, using the Cormack-Lehan scale, also favored the GlideScope (2 [1,2] versus 2[2,2]; p=0.044). There was no difference in first-pass success rates (100% versus 100%). More participants preferred the GlideScope (24 versus 9; p=0.165); however, participants agreed that the i-view would be easier to use than the GlideScope in an austere environment (4[4,5]). CONCLUSIONS We found the GlideScope outperformed the i-view with respect to procedural completion time. Participants preferred the GlideScope over i-view, but indicated the i-view would be easier to use than the GlideScope in an austere setting. Our findings suggest the i-view may be a suitable alternative to GlideScope for US military providers, especially for those in the prehospital setting.
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Sorensen DA, April MD, Fisher AD, Schauer SG. An Analysis of the Shock Index and Pulse Pressure as a Predictor for Massive Transfusion and Death in US and Coalition Iraq and Afghanistan. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:63-68. [PMID: 34449863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Among combat casualties with survivable injuries, the most common cause of mortality is massive hemorrhage. The objective of this study was to identify the accuracy of shock index (SI) and pulse pressure (PP) for predicting receipt of massive transfusion and death on the battlefield. The study searched the Department of Defense Trauma Registry from January 2007 to August 2016 using a series of procedural codes to identify casualties which has been previously described. This is a secondary analysis of casualties analyzing SI. This study analyzed using receiver operating characteristic (ROC) and regression analyses. Within that dataset, there were 15,540 that were US Forces (75.1%), Coalition Forces (14.5%) or contractors (10.3%)-of which, 1,261 (7.9%) underwent massive transfusion. On ROC analyses for SI, this study found an overall optimal threshold at 0.91 with an area under the curve (AUC) of 0.89 with a sensitivity of 0.81 and specificity of 0.87 for predicting massive transfusion. The study found an optimal threshold of 0.91 with an AUC of 0.76 with a sensitivity of 0.67 and specificity of 0.82 for predicting death. On ROC analyses for PP, the study found an overall optimal threshold at 48 with an AUC of 0.71 with a sensitivity of 0.56 and specificity of 0.76 for predicting massive transfusion. The study found an optimal threshold of 44 with an AUC of 0.75 with a sensitivity of 0.60 and specificity of 0.82 for predicting death. SI and PP may accurately predict receipt of massive transfusion and of mortality in a combat casualty population.
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Martin SM, Fisher AD, Meledeo MA, Wampler D, Nicholson SE, Raczek K, April MD, Weymouth WL, Bynum J, Schauer SG. More sophisticated than a drink cooler or an old sphygmomanometer but still not adequate for prehospital blood: A market review of commercially available equipment for prehospital blood transport and administration. Transfusion 2021; 61 Suppl 1:S286-S293. [PMID: 34269456 DOI: 10.1111/trf.16461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/16/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of death in trauma patients with most fatalities occurring before reaching a higher level of care-this applies to both the civilian setting and the military combat setting. Hemostatic resuscitation with increased emphasis on blood transfusion while limiting use of crystalloids has become routine in trauma care. However, the prehospital setting-especially in combat-presents unique challenges with regard to storage, transport, and administration. We sought to evaluate available technology on the market for storage and administration technology that is relevant to the prehospital setting. STUDY DESIGN AND METHODS We conducted a market review of available technology through subject-matter expert inquiry, reviews of published literature, reviews of Federal Drug Administration databases, internal military publications, and searches of Google. RESULTS We reviewed and described a total of 103 blood transporters, 22 infusers, and 6 warmers. CONCLUSIONS The risk of on-scene fatality in trauma patients and recent developments in trauma care demonstrate the need for prehospital transfusion. These transfusions have been logistically prohibited in many operations. We have reviewed the current commercially available equipment and recommended pursuit of equipment that improves accessibility to field transfusion. Current technology has limited applicability for the prehospital setting and is further limited for the military setting.
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Mould-Millman NK, Mata L, Schauer SG, Dixon J, Keenan S, Holcomb JB, Tobin JM, Moore E, de Vries S, Bedard A, Bebarta VS, Ginde AA. Defining Combat-Relevant Endpoints for Early Trauma Resuscitation Research in a Resource-Constrained Civilian Setting. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021; PB 8-21-07/08/09:3-14. [PMID: 34449854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Studies assessing early trauma resuscitation have used long-term endpoints, such as 28- or 30-day mortality or Glasgow Outcomes Scores at 6-months. These endpoints are convenient but may not accurately reflect the effect of early resuscitation. We sought expert opinion and consensus on endpoints and definitions of variables needed to conduct a Department of Defense- (DoD) funded study to epidemiologically assess combat-relevant mortality and morbidity due to timeliness of resuscitation among critically injured civilians internationally. METHODS We conducted an online modified Delphi process with an international panel of civilian and US military experts. In several iterative rounds, experts reviewed background information, appraised relevant scientific evidence, provided comments, and rendered a vote on each variable. A-priori, we set consensus at ≥80% concordant votes. RESULTS Twenty panelists participated with a 100% response rate. Eight items were presented, with the following outputs for the epidemiologic study: Assess mortality within 7-days of injury; assess multi-organ failure using SOFA scores measured early (at day 3) and late (at day 7); assess traumatic brain injury mortality early (≤7-days) and late (28-days); hybrid (anatomic and physiologic) injury severity scoring is optimal; capture comorbidities per the US National Trauma Data Standard list with specific additions; assign resuscitative interventions to one of five standardized phases of trauma care; and, use a novel trauma death categorization system. CONCLUSIONS A modified Delphi process yielded expert-ratified definitions and endpoints of variables necessary to conduct a combat-relevant epidemiologic study assessing outcomes due to early trauma resuscitation. Outputs may also benefit other groups conducting trauma resuscitation research.
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Spanier AM, Jude JW, Hiller H, Cunningham C, Hill GJ, Weymouth W, Schauer SG. Prehospital Intervention Analysis of Helicopter Crashes in Afghanistan. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:69-73. [PMID: 34449864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Based on isolated case reports, military helicopter mishaps often result in multiple critical casualties leading to complicated stabilization and evacuation by healthcare providers. The aim of this retrospective descriptive analysis is to describe the incidence of common prehospital injuries associated with rotary wing crashes in order to improve mission planning and casualty survivability. METHODS This is a secondary analysis of data from the Prehospital Trauma Registry and the Department of Defense Trauma Registry (DoDTR) from April 2003 through May 2019. We searched within our dataset for all encounters involving aviation crashes. RESULTS From April 2003 through May 2019 there were 1,357 casualty encounters in the Prehospital Trauma Registry. There were 12 casualties identified injured by aircraft crash, of which, 10 were linkable to the DoDTR for outcome data. All encounters for this sub analysis occurred in Afghanistan in 2014, all were US military service members, and a majority were enlisted conventional forces. Most prehospital interventions focused on hemorrhage control, to include limb tourniquets (n=3), pressure dressings (n=2), and pelvic splint (n=1). One patient received a cervical collar and two patients received temperature control with a hypothermia kit. CONCLUSIONS In this case series, hemorrhage control and extremity stabilization accounted for the majority of prehospital interventions. Larger datasets are needed to validate findings and extrapolate it into mission planning.
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Sletten Z, Shemery N, Aden JK, Morris M, Long B, Schauer SG. The Impact of Military Emergency Medicine Scholarly Activity. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:57-62. [PMID: 34449862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Emergency medicine is recognized as a critical wartime specialty within the US military. Military emergency medicine contributes to medical literature in unique ways not seen with our civilian counterparts. The impact of this contribution, especially regarding innovations in military medicine, has not been previously examined. This study evaluates the numbers of citations for emergency medicine manuscripts published by members of the US military. METHODS Utilizing the Scopus database, we identified published manuscripts from 2000 to 2020 with an emergency medicine author affiliated with a US military treatment facility. We sorted manuscripts on the number of citations in Scopus and categorized each paper as to whether it addressed military unique topics. RESULTS We identified 1,718 manuscripts through Scopus, and based on a 10-citation minimum, we further analyzed 508 manuscripts. After verification of military affiliation, we included 421 manuscripts. The mean number of citations per manuscript was 31.7 ± 40.5; the Mean Cite Score was 4.75 ± 6.17 with a Field Weighted Citation Index (FWCI) of 2.96 ± 6.25. Citation count of publications has been steadily increasing in recent years with significantly more citations for military relevant publications when compared to non-military relevant publications. CONCLUSIONS These findings highlight the importance of military emergency medicine scholarly activity which has a history of contributions that address specific medical needs of the warfighter and advance the specialty. Military emergency medicine papers have seen rising numbers of citations in the medical literature, particularly those related to military relevant topics emphasizing combat casualty care and military readiness.
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Myers MA, Chin EJ, Billstrom AR, Cohen JL, Van Arnem KA, Schauer SG. Ultrasound at the Role 1: An Analysis of After-Action Reviews from the Prehospital Trauma Registry. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:20-24. [PMID: 34449856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Ultrasound is a portable and adaptable imaging modality used widely in the care of trauma patients. The initial exam, known as the "Focused Assessment in Trauma (FAST) exam focused on the evaluation for hemoperitoneum and hemopericardium. In recent years, the exam has expanded to include evaluate for thoracic pathology, including pneumothorax, and is now known as the "Extended Focused Assessment in Trauma" (E-FAST) exam. METHODS We reviewed after-action reviews (AAR) from the Joint Trauma System Prehospital Trauma Registry from 2013-2014 in which the use of an ultrasound exam was noted. Given the largely unstructured nature of the AARs, we selected relevant information from the free text available. RESULTS Our initial dataset contained 705 casualties, of which we identified 45 cases containing the key words with AAR data for review: 39 cases involved the use of the FAST exam, three explicitly described the use of pulmonary ultrasound and they were categorized as E-FAST exams, two cases described the use of point of care echo to evaluate for cardiac standstill, and two cases described the use of ultrasound to evaluate for vascular injury. Of those with vital signs documented, 25% (11) reported at least one episode of tachycardia (≥120/min) and 16% (7) with at least one episode of systolic hypotension (less than 90mmHg). Of the 45 cases reviewed, six were recorded as equivocal, which we interpreted to indicate more training in either performance or interpretation of the exam was needed. CONCLUSIONS Our findings suggest that training in both the FAST exam and E-FAST has the potential to improve patient care for military trauma patients. A performance improvement system would enable real-time confirmation of findings and feedback for training and quality improvement.
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Uhaa N, Jeschke EA, Gwynne AM, Hudson IL, Mendez J, April MD, Weymouth WL, Parsons DL, De Lorenzo RA, Schauer SG. An Assessment of Combat Medic Supraglottic Airway Device Design Needs Using a Qualitative Methods Approach: A Preliminary Analysis. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:90-96. [PMID: 34449867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Airway obstruction is the second leading cause of potentially preventable death on the battlefield during the recent conflicts. Previous studies have noted challenges with enrolling medics using quantitative methods, with specific challenges related to limited prior experience with the devices presented. This limited the ability to truly assess the efficacy of a particular device. We sought to implement a qualitative methods design for supraglottic airway (SGA) device testing. METHODS We performed prospective, qualitative-designed studies in serial to discover emerging themes on interview. We obtained consent and demographic information from all participants. Medics were presented 2-3 airway devices in the same session with formal training by a physician with airway expertise to include practice application and troubleshooting. Semi-structured interviews were used after the training to obtain end-user feedback with a focus on emerging themes. RESULTS Of the 77 medics surveyed and interviewed, the median age was 24, and 86% were male. During the interview sessions, we noted five emerging themes: (1) insertion, which pertains to the ease or complexity of using the devise; (2) material, which pertains to the tactile features of the device; (3) versatility, which pertains to the conditions in which the device can be used as well as with which other devices it can be used; (4) portability, which refers to how and where the device is stored and carried; and (5) training, which refers to the ease and frequency of initial and ongoing training to sustain medics' technical capability when using the device. CONCLUSIONS In our preliminary analysis after enrolling 77 medics, we noted 5 emerging themes focused on insertion material, versatility, portability, and training methodology. Our results will inform the future enrollment sessions with a goal of narrowing the market options from themes to ideal device or devices or modifications needed for the operational environment.
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Schauer SG, Naylor JF, April MD, Fisher AD, Bynum J, Kotwal RS. 16 Years of Role 1 Trauma Care: A Descriptive Analysis of Casualties within the Prehospital Trauma Registry. MEDICAL JOURNAL (FORT SAM HOUSTON, TEX.) 2021:44-49. [PMID: 34449860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Most battlefield deaths occur in the prehospital setting prior to reaching surgical and hospital care. Described are casualties captured by the Joint Trauma System (JTS) in the Prehospital Trauma Registry (PHTR) module of the Department of Defense Trauma Registry (DoDTR), from inception through May 2019. METHODS The JTS was queried for all PHTR encounters and associated data from inception (January 2003) through May 2019. The PHTR captures data on Role 1 prehospital care which encompasses treatment prior to arrival at a Role 2 with or without forward surgical team or Role 3 combat support hospital. Two unique patient identifiers were used to link DODTR outcome data to each PHTR encounter. Descriptive statistics were used to analyze the data. RESULTS We obtained a total of 1,357 encounters from the PHTR. Of these encounters, we successfully linked 52.2% (709/1357) to the DODTR for outcome data. Encounters spanned from 2003 to 2019, with most (69.5%) occurring from 2012 to 2014. Many casualties were in the 18-25 (25.5%) or 26-33 (27.0%) age ranges, male (99.2%), injured by explosive (47.1%) or firearm (34.8%), enlisted (44.8%), and US military conventional (24.1%) and special operations (23.9%) forces. Of those linked to the DODTR, demographics were similar, most casualties sustained battle injuries (87.1%), the majority of which survived (99.1%). CONCLUSIONS We described 1,357 encounters within the PHTR, most of which were US casualties and casualties injured by explosives. This renewed effort by the JTS to capture more casualties for inclusion into the registry has nearly doubled the proportion of available encounters for analysis. This analysis lays the foundation for in-depth analyses targeting areas for optimizing Role 1 prehospital combat casualty care.
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