Отправить письмо автору 
Написать комментарий 
ARRANGEMENT AND STRATEGIES OF PREHOSPITAL CARE FOR VICTIMS IN CONDITIONS OF MODERN WARFARE: EXPERIENCE OF MILITARY FORCES OF NATO COUNTRIES IN IRAQ AND AFGHANISTAN
Rovenskikh D.N., Usov S.A., Shmidt T.V.
EvroMedclinica Plus, Army General Yakovlev Novosibirsk Military Institute of National Guard Forces of the Russian Federation, Novosibirsk, Russia
Positive changes in arrangement of prehospital medical care for military victims in the first decade of the 21st century can be characterized as groundbreaking [1]. During war conflicts in Iraq and Afghanistan, the lowest mortality among victims has been achieved over the whole period of U.S. military forces. The analysis of 56,763 cases of injuries in U.S. military men showed the decrease in mortality from 20 % to 8.6 % in Afghanistan, and to 10.1 % in Iraq. Moreover, the survival rate in patients with critical ISS (27-75) has increased from 2.2 % to 39.9 % (Afghanistan), and from 8.9 % to 32.9 % (Iraq) [2]. Among British military personnel, the values of New Injury Severity Score (NISS), relating to 50 % chance for survival gradually increased from 32 in 2003 to 60 in 2012 [3]. The achieved results can be mainly explained by improvement in quality of components of arrangement of medical care at the prehospital stage [2]. The presented foreign literature review is dedicated to analysis of these advancements. PubMed, Cochrane, and available Internet recourses were analyzed.
Features of modern combat injury and the idea of potentially preventable death
During Iraqi Freedom and Enduring
Freedom military operations, and
subsequent (still ongoing) long term combat activity against irregular
military troops in the territory of Afghanistan, where the epicenter of the war
is located now, the following features of the modern combat injury have been
identified:
1. Constant and wide use of measures for
armor protection (body armour, kevlar helmets) has caused the significant
decrease in incidence of injuries to the body and the skull, with corresponding
increase in injuries to unprotected parts of the body (extremities, face, neck
etc.) [3, 4].
2. Tactics of insurgents - mainly,
avoidance of direct firefight, and the wide use of self-made explosive devices
(SMED) − has resulted in high incidence of mine-blast injury with traumatic
detachment or crush injury to extremities [5, 6, 7]: up to 70-75 % of all
combat injuries [3, 4, 5, 6]. Due to high power of SMED, the incidence of
polytrauma has increased: extensive injuries (above the level of ankle or
forearm), including bilateral ones, with pelvic fractures, perineal and genital
urinary injuries, abdominal, thoracic and CNS injuries [4, 8, 9, 10].
During the analysis of autopsy
results in 4,569 military men with combat injuries for the period from October,
2001, to June, 2011, BJ Eastbridge et al. found that mine-blast injury was the
cause of death in 70.3 % of cases, gunshot injuries - in 22.1 %, others - in
4.2 %. The unpreventable causes of death (fatal injuries) were body dissection,
severe cerebral injuries (evisceration, penetrating cranial injuries with
injuries to basal nuclei or to big vascular structures and brain stem)), full
dissection of cervical spine above C3, involvement of respiratory tracts in
thoracic region, cardiac injuries with length > 1/2 inch, thoracic aorta and
pulmonary artery injuries, liver laceration (sixth degree), catastrophic
abdominal and pelvic injuries with amputation of the lower extremity, with
opened pelvic fracture and with high losses of soft tissues (traumatic
hemipelvectomy). Death after all other injuries was considered as potentially
preventable. In the analyzed group, 87.3 % of victims died at the prehospital
stage, with 75.5 % of cases estimated as unpreventable death, and with 24.3 %
- as potentially preventable. The cases of potentially preventable death included
bleeding (90.9 %) and respiratory system injuries (8 %). The sources of fatal
bleeding were injuries to distal parts of extremities in 13.5 %, junctional
injuries - in 19.2 %, and body damages - in 67.3 %. Body damages included
thoracic injuries in 36 %, and abdominal and pelvic injuries in 64 % [6].
Therefore, massive bleeding, tension
pneumothorax and airway obstruction were the main causes of potentially
preventable death during military operations in Iraq and Afghanistan. Massive
blood loss was the main cause (more than 80 % of cases of preventable
death),whereas the proportion of tension pneumothorax and airway obstruction,
and thoracic injury-related respiratory disorders was 10-15 % [5, 6, 11, 12,
3].
J Kelly et al. analyzed 232 cases of
deaths in 2003-2006 and found that bleeding was the cause of death in 81 % of
victims with non-fatal injuries. They distributed types of bleeding into
"tourniquet" bleeding (arrested with application of the tourniquet
from the individual first-aid kit) (TB), "non-tourniquet, but potentially
responsive to compression bleeding" in injuries to regions of joints to
the body (neck, perineal region, axillary cavity) (NTPRCB), and to
compression-resistant bleeding (CRB). Bleeding in the mentioned locations were
the cause of death in wounded persons with potentially non-life-threatening
injuries in 20 %, 30 % and 50 %, correspondingly [7].
CRB is determined as bleeding in an
injury to one or several regions: magistral vessels of the body, pulmonary
injuries, injuries to parenchymal abdominal organs (liver, kidneys, spleen;
degree 4 and higher), or pelvic fractures with pelvic ring rupture. Here,
unstable hemodynamics is observed, and/or urgent bleeding arrest is required.
In the group of 296 wounded persons with such injuries, the mortality was 85.5
%; most of them (75 %) died at the prehospital stage [14, 15].
Therefore, the most significant
problem is aid for victims with CRB and NTPRCB, although most bleedings after
combat injuries are assigned to TB, considering that limb injuries are more
frequent [3, 16].
The features of modern
combat injury, and the structure of causes of subsequent conditions in wounded
military men determine the changes in the training system for military
personnel, in improvement of provision, and in strategies and techniques for
arrangement of prehospital medical care [17].
Training of military personnel in arrangement of medical aid for combat injury
The system of arrangement of medical care for wounded persons in NATO armies is divided into five levels; the first level is prehospital [18]. At this stage, the arrangement of primary care is realized as self-care or buddy care (performed by any serviceman who received basic training). Moreover, at the present time, the basic training for arrangement of care is performed for at least one soldier in each division who receives the lifesaver status. Besides the basic skills in care arrangement, military servicemen are trained to install the nasopharyngeal tube, to perform pleural cavity decompression with the puncture needle under supervision of the combat medic. Each troop has the combat medic who has skills in urgent medical care (emergency medical technician) of B level (basic),with special 16-week training (EMT-B). Prehospital medical care is also conducted by more qualified paramedics who work in military troops [12]. Names of their job positions can vary in dependence on branches of army (ground troops, marines, air force, special operation forces) [18]. The perfect example is the training system for 75th Ranger Regiment of the U.S. Army. In this division, all military servicemen receive basic training in medical care for wounded persons. The special accent is given to bleeding arrest. Moreover, annual retraining, and additional intensive two-week training for arrangement of care for wounded are carried out before each duty in Afghanistan. Arrangement of care for victims with combat injuries is included into scenario of tactical trainings of rangers. At the level of subdivision, one military man is trained as EMT-B, at the level of a troop − as medical ranger (16-week training program for military medical specialist, or 26-week program for medical specialist of special ops forces) [11].
Tactics of care arrangement for wounded in action
In the U.S. Army and in other NATO
armies, the main direction for arrangement of care for combat injury is Tactical
Combat Casualty Care (TCCC), which is published for all participants of
military actions and for military medical specialists and paramedics. It is
developed by the TCCC Committee, which works with Joint Trauma System (JTS) of
Institute of Surgical Research of the U.S. Army. The committee includes volunteers
(who have main job in U.S. Military Forces or in the U.S. Government), trauma
surgeons, critical care medicine specialists, physicians and assistant
physicians in critical care medicine, health care providers for wounded in
action, specialists in military medical training for servicemen). Each member of
the Committee participated in military operations. At least 30 % of them were
or are combat medics (for ground forces), corpsmen (marines) or pararescue
jumpers (PJs) (Air Force Special Ops Command). 42 members of the Committee with
voting power present the army, air forces, war fleet, marines and United States
Coast Guard. The expert estimation of results of activity of TCCC committee is
made by the U.S. Main Surgeon, and by the head of Trauma Committee of American
College of Surgeons [19].
TCCC is regularly republished along
with accumulation of new data on results of care arrangement for wounded, data
analysis, conclusions, results of practical use, and development of new
measures for care arrangement [19, 20, 21]. Currently, TCCC is the standard of
prehospital care for wounded in action [16].
During preparation of
the manual, the patterns of combat injury are taken into attention, as well as
the structure of causes of potentially preventable deaths, and understanding of
the facts that arrangement of care for wounded in combat has its own specifics.
This specifics include:
1. Threat of enemy fire for a victim
or a person who renders care.
2. The need for primary focus on main
causes: bleeding, pneumothorax, airway obstruction.
3. Time of evacuation to a medical
facility can take much more time than for an accident in a city in peaceful
time.
4. Combat medics and paramedics can
be well trained, but they can have much less experience in arrangement of care
as compared to their civilian colleagues.
5. A single incident (a blast,
firefight) can involve a lot of victims.
6. Care is realized in
extremely unfavorable conditions: mountain or desert areas, night time and
others [11, 19].
Moreover, a wounded soldier presents
not only medical, but also tactical problem, which impedes realization of a
battle mission. It requires for adherence to strict consequence of the
following interrelated actions:
1. To arrange care for a victim.
2. To prevent emergence of other
victims by means of massive counterstrike.
3. And the main thing
- to successfully compete the mission of a subdivision [11].
Considering theabove-mentioned facts, 3 phases of care for a victim are presented:
1. Care under enemy fire.
2. Tactical field care.
3. Assistance during evacuation
of a victim [11, 12].
This phasal nature provides the best
arrangement of care without decreasing efficiency of military actions by small
subdivisions [19].
In the first phase, the
care includes dragging a victim to the nearest shelter, and Combat Application
Tourniquet (CAT). All other problems are solved after elimination of thereat of
fire for a victim and for a soldier who helps with direct counterstrike (the
phases 2, 3) [11, 12, 20, 21]. The subsequence of examination of a victim, and
subsequence of care actions for life-threatening combat injuries are determined
by MARCH mnemonic hint (currently - MARCH PAWS) [23]:
Massive hemorrhage
control. It is commonly performed as self-care or buddy care by any military
man. According to the data by E Savage, who analyzed the experience in care
arrangement for Canadian wounded servicemen in Afghanistan, non-medical staff
performed 26 % of cases of bleeding arrest (including 42 % of tourniquet
application) [12].
Airway management: from
stable positioning to installment of the nasopharyngeal tune, and
coniotomy.
Respiratory management:
occlusive dressing with outlet valve in opened pneumothorax, and puncture
thoracocentesis with the catheter needle for tension pneumothorax.
Circulation: search for
other sources of external bleeding, hemostasis, intravenous or intraosseous
approach, infusion-transfusion therapy, estimation of applied tourniquets and
their replacement to compressing dressings if possible.
Hypothermia, Head injury.
Pain relief.
Antibiotics.
Wounds dressing.
Splinting.
Certainly, the important factors of
efficient care for combat injury are rapidness of evacuation from the accident
site to medical facilities with recourses for qualified surgical care (at
least, level 2 of care [18]). In 2009, the Secretary of Defense set a task of
helicopter transportation for critically ill patients from the accident site to
the nearest medical facility within 60 minutes (the golden hour). Gradually,
the percentage of missions with helicopters for evacuation of victims within 60
minutes increased from 24.8 % (181 of 731) to 75.2 % (2,867 of 3,811) (p <
0.001). Moreover, among all wounded, the percentage of deceased persons at the
prehospital stage, and mortality decreased: the first value - from 16 % (386 of
2,011) to 9.9 % (964 of 9,755) (p < 0.001); the second value - from 13.7 %
to 7.6 % (1,344 of 17,660) (p < 0.001). The rate of deceased patients in
hospitals remained the same (4.1-4.3 %).
The decrease in mortality after
setting this task was associated with increasing amount of patients transferred
by a helicopter within the first 60 minutes after wound (regression coefficient
-0.141; p < 0.001). The number of saved lives was 359 cases higher than the
predicted number.
The prehospital mortality in critical
wounded persons was lower than in patients with
hemotransfusion (6.8 % (40 of 589) against 51 % (249 of 488), p <
0.001), and in persons transferred by a helicopter within 60 minutes after
wound (25.7 % (205 of 799) vs. 30.2 % (84 of 278), p < 0.01) [23].
Besides rapidness of
evacuation, the quality of prehospital care can be improved. For evacuation of
critically ill victims, British military servicemen use the military transport
helicopter Chinook, with Medical Emergency Response Team (MERT). MERT is headed
by a qualified physician with experience in intensive care. The team also includes
two paramedics, and a nurse. They are accompanied by four armed soldiers for
provision of additional safety during transportation. Actually, a helicopter
presents the mobile and well-equipped intensive care unit with possibilities
for narcosis, pleural cavity draining, tracheal intubation, coniotomy,
transfusion of whole blood and/or its components through venous approach, as
well as other manipulations, operations or procedures [17]. The comparison of
results of activities of MERT helicopter teams and PEDRO teams headed by a
paramedic (U.S. Air Forces) showed that the mortality in patients with ISS of
20-29 was lower than in MERT (4.8 % vs. 16.2 %, p = 0.021) [24].
CONCLUSION
The wide use of tourniquets for
massive blood loss, blood transfusion, and faster transportation to hospital determined
the decrease in total mortality in victims with combat injuries by 44.2 % [2].
Moreover, the mortality from bleedings after limb injuries was 7.8 % in Vietnam
war [7], and it decreased to 2.6 % in the end of 2011 (military operations in
Afghanistan) - by 67 % [19].
The list of main
components of prehospital care for combat injury, which promoted such positive
changes, was described by FK Butler [19] (some links to publications are
presented):
Phasal
nature of prehospital care with optimal combination of quality for a victim,
and strategies of actions for subdivisions [11, 12].
Active
use of TCCC-recommended tourniquets for primary control of external bleeding,
and removal of tourniquets (if possible) at the stages 2-3 of care [17, 25,
26].
The use
of TCCC-recommended hemostatic dressings for NTPRCB [25, 27].
The use of compression tourniquets for
junctional injuries for arrest of NTPRCB [28, 29].
Sitting
position with forward lean for prevention of dislocation and aspiration
asphyxia.
If it
is impossible, use of coniotomy with Cric-Key technique [30].
Active
use of puncture draining of pleural cavity with the catheter-needle ( 14-G or
10-G diameter, length - 3.25 inches) in case of suspected tension pneumothorax
[20, 21, 31, 32].
Application
of sealing dressings with outlet valve for opened pneumothorax [21, 33].
Installation
of intravenous catheter only for cases with evident need for intravenous
injections and infusions [34].
The
preference to "the lock" with crystalloid solution with constant
infusion of fluid for maintenance of patency of the catheter [21].
The use
of intraosseous infusions if venous approach is impossible [21, 35].
The
early use of tranexamic acid at the prehospital stage (before initiation of
infusion of other fluids) for victims with hemorrhagic shock or high risk of
its development [36].
Intensive
transfusion therapy of whole blood or its components (packed red blood cells
and plasma) with 1:1 ratio at the prehospital stage (if possible) [21, 37].
If no
- infusion of hydroxyethyl starch (in TCCC - Hextend, Hospira Inc., Lake Forest,
Illinois, USA) with maintenance of moderate hypotension [34, 38].
Safer,
faster and more efficient correction of pain syndrome with use of three-variant
approach to analgesia on the battlefield: paracetamol and maloxicam for slight
injuries; preferred use of lozenges with phentanyl, and intravenous
introduction of ketamine instead of intramuscular introduction of morphine for
strong pain [21, 39].
The use
of ondansentronum for nausea caused by trauma or opioids [21].
Prevention
of hypothermia and secondary coagulopathy be means of use of advanced
technologies for prevention of warm losses [40].
Prehospital
antibiotic prevention of wound infections, their complications and death with
use of maxifloxacin or ertapenem [21].
Training
of arrangement of medical care in small subdivisions in various combat
conditions.
The use
of data from TCCC casualty card and electronic TCCC medical after-action reports for objective
documentation of details and total level of care arrangement.
For bleeding arrest, along with
compressing dressings, and wound packing with hemostatic gauze for NTCRCB and
RCB, it is recommended to use new techniques: injector of synthetic hemostatic
sponges XStat™ (for narrow and deep wounds in junction sites), and hemostatic
clamp iTClamp (individually or in combination with XStat™) [21, 41, 42].
Therefore, the achieved progress has
been determined by combination of optimal (for reality of modern warfare)
organization and strategies of prehospital care for combat victims, with
constant improvement in ways for arrangement of care on the basis of advances
in medical science and medical technologies. The mean principles of prehospital
care for victims with combat injuries are successfully used in civilian
medicine in development of programs for arrangement of medical care for victims
of terroristic attacks and mass shooting (for example, Hartford consensus, Stop
Bleed program [43, 44, 45]), and actions of special helicopter teams and ground
teams in such extreme situations [17, 35].
Information on financing and conflict of interest
The study was conducted
without sponsorship.
The authors declare the
absence of any clear and potential conflicts of interests relating to
publication of this article.
REFERENCES:
1. Blackbourne LH,
Baer DG, Eastridge BJ, Kheirabadi B,
Bagley S, Kragh JF Jr, et al. Military medical revolution: prehospital
combat casualty care. J
Trauma Acute Care Surg. 2012; 73(6 Suppl 5): S372-S377
2. Howard JT, Kotwal RS, Stern CA, Janak JC, Mazuchowski EL, Butler FK, et al. Use of combat casualty care data to аssess the US Military Trauma System
during the Afghanistan and Iraq conflicts, 2001-2017. JAMA Surg. 2019; 154(7): 600-608
3. Penn-Barwell JG, Roberts SA, Midwinter MJ, Bishop JR. Improved survival in UK combat
casualties from Iraq and Afghanistan: 2003-2012. J Trauma Acute Care
Surg. 2015; 78(5): 1014-1020
4. Belmont PJ, Schoenfeld AJ, Goodman G. Epidemiology of combat wounds in
Operation Iraqi Freedom and Operation Enduring Freedom: orthopaedic burden of
disease. J Surg Orthop Adv. 2010; 19(1): 2-7
5. Eastridge BJ, Hardin M, Cantrell J, Oetjen-Gerdes L, Zubko T, Mallak C, et al. Died of wounds on the
battlefield: causation and implications for improving combat casualty care. J Trauma. 2011; 71(1)(suppl): S4-S8
6. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the
future of combat casualty car. J Trauma Acute Care Surg. 2012;
73(6 Suppl 5): S431-S437
7. Kelly JF, Ritenour AE, McLaughlin DF, Bagg KA, Apodaca AN, Mallak CT, et al. Injury severity and causes of death from Operation Iraqi Freedom
and Operation Enduring Freedom: 2003-2004 versus 2006. J Trauma. 2008; 64(2 Suppl): S21-S26
8. Andersen RC, Fleming M, Forsberg JA, Gordon WT, Nanos GP, Charlton MT, et al. Dismounted
сomplex blast injury. J Surg Orthop Adv. 2012; 21(1): 2-7
9. Dismounted Complex Blast Injury. Report of
the Army Dismounted Complex Blast Injury Task Force. Fort Sam Houston, TX.
2011. [Internet] Available from: https://docplayer.net/7727721-Dismounted-complex-blast-injury-report-of-the-army-dismounted-complex-blast-injury-task-force.html
10. Mamczak CN, Elster EA. Complex dismounted
IED blast injuries: the initial management of bilateral lower extremity
amputations with and without pelvic and perineal involvement. J Surg Orthop Adv. 2012; 21(1): 8-14
11. Kotwal RS, Montgomery HR, Kotwal BM,
Champion HR, Butler FK Jr, Mabry RL, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011; 146(12): 1350-1358
12. Savage E, Forestier C, Withers N, Tien H,
Pannell D. Tactical Combat Casualty Care in the Canadian Forces: lessons
learned from the Afghan war. Can J Surg.
2011; 54(6 Suppl): S118-S123
13. Hardy GB, Maddry JK, Ng PC, Savell SC, Arana AA, Kester A, et al. Impact of prehospital airway management on combat mortality. Am J Emerg Med. 2018; 36(6): 1032-1035
14. Morrison JJ, Stannard A, Rasmussen TE, Jansen JO, Tai NR, Midwinter MJ. Injury pattern
and mortality of noncompressible torso hemorrhage in UK combat casualties. J Trauma Acute Care
Surg. 2013; 75(2 Suppl 2): S263-8
15. Morrison JJ. Noncompressible Torso Hemorrhage. Crit Care Clin. 2017; 33(1): 37-54
16. Puryear B, Knight C. EMS, Tactical Combat
Casualty Care. Treasure Island (FL): StatPearls Publishing; 2020-2019, Feb 28. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532260/
17. Brown KV, Guthrie HC, Ramasamy A, Kendrew JM, Clasper J. Modern military surgery: lessons from Iraq and Afghanistan. J Bone Joint Surg Br. 2012; 94(4): 536-543
18. Bagg MR, Covey DC, Powell ET 4th. Levels of
medical care in the global war on terrorism. J Am Acad Orthop Surg. 2006; 14(10 Spec No.): S7- S 9
19. Butler FK. Two decades of saving lives on
the battlefield: tactical combat casualty care turns 20. Mil Med. 2017; 182(3-4): e1563-e1568
20. Tactical combat casualty care guidelines for
all combatants. August 2017. Based on TCCC Guidelines for Medical Personnel
170131. [Internet] [cited 2019 Nov 23]. Available from: http://www.naemt.org/docs/default-source/education-documents/tccc/tccc-ac/updates-1708/00-tccc-ac-guidelines-1708/tccc-guidelines-for-all-combatants-1708.pdf?sfvrsn=7559ca92_2
21. TCCC Guidelines for Medical Personnel. 1
August 2019. [Internet] [Place
unknown].deployedmedicine.com/market/31/content/40.[cited 2019 Nov 23].
Available from: https://books.allogy.com/web/tenant/8/books/b729b76a-1a34-4bf7-b76b-66bb2072b2a7/
22. Kosequat J, Rush SC,
Simonsen I,Gallo I, Scott A, Swats K et al. Efficacy of the mnemonic device «MARCH
PAWS» as a checklist for pararescuemen during tactical field care and tactical
evacuation. J Spec Oper Med. 2017; 17(4): 80-84
23. Kotwal RS, Howard JT, Orman JA, Tarpey BW,
Bailey JA, Champion HR, et al. The effect of a golden hour policy on the
morbidity and mortality of combat casualties. JAMA Surg. 2016; 151(1): 15-24
24. Apodaca A, Olson CM , Bailey J, Butler F,
Eastridge BJ, Kuncir E. Performance improvement evaluation of forward
aeromedical evacuation platforms in Operation Enduring Freedom. J Trauma Acute Care Surg. 2013; 75(2)
(suppl. 2): S157-S163
25. Holcomb JB, Butler FK, Rhee P. Hemorrhage
control devices: tourniquets and hemostatic dressings. J Spec Oper Med. 2015; 15(4): 153-156
26. Kragh JF Jr, Dubick MA.
Battlefield tourniquets: lessons learned in moving current care toward best
care in an Army Medical Department at war. US Army Med Dep J. 2016; (2-16): 29-36
27. Bennett BL. Bleeding control using hemostatic dressings: lessons learned. Wilderness Environ
Med. 2017; 28(2S): S39-S49
28. Flecha I, Naylor JF, Schauer SG, Curtis RA, Cunningham CW. Combat lifesaver-trained, first-responder application of junctional
tourniquets: a prospective, randomized, crossover trial. Mil Med Res. 2018; 5(1): 31
29. Schauer SG, April MD, Fisher AD, Cunningham CW, Gurney J. Junctional tourniquet use during
combat operations in Afghanistan: the Prehospital Trauma Registry experience. J Spec Oper Med. 2018; 18(2): 71-74
30. Mabry RL, Kharod CU, Bennett BL. Awake cricothyrotomy: a novel approach to the surgical airway in the
tactical setting. Wilderness Environ Med. 2017; (2S): S61-S68
31. Butler FK, Holcomb JB, Shackelford S, Montgomery HR, Anderson S, Cain JS. Management of suspected tension pneumothorax in Tactical Combat
Casualty Care: TCCC Guidelines Change 17-02. J Spec Oper Med. 2018; 18(2): 19-35
32. Littlejohn LF. Treatment of thoracic trauma:
lessons from the battlefield adapted to all austere environments. Wilderness Environ Med. 2017; 28(2 S): S69-S73
33. Butler FK, Dubose JJ, Otten EJ, Bennett DR,
Gerhardt RT, Kheirabadi BS, et al. Management of open pneumothorax in tactical
combat casualty care: TCCC guidelines change 13-02. J Spec Oper Med. 2013; 13(3): 81-86
34. Mabry RL, Cuenca PJ.Should we teach every soldier how to
start an IV? Mil Med. 2009; 174(6): III-V
35. Heiskell LE, Olenecky BT, Vail SJ. Tactical
Medicine. In: Wilderness medicine. edited
by Paul S. Auerbach. 6th ed. ELSEVIER MOSBY Philadelphia, 2012. P. 488-506
36. Morrison JJ, Dubose JJ, Rasmussen TE,
Midwinter MJ. Military Application of Tranexamic Acid in Trauma Emergency
Resuscitation (MATTERs) Study. Arch Surg.
2012; 147(2): 113-119
37. Butler FK. Fluid resuscitation in Tactical
Combat Casualty Care: yesterday and today. Wilderness Environ Med. 2017; 28(2S): S74-S81
38. Holcomb JB. Fluid resuscitation in modern
combat casualty care: lessons learned from Somalia. J Trauma. 2003; 54(5 Suppl): S46- S 51
39. Wedmore IS, Butler FK Jr. Battlefield Analgesia in Tactical Combat Casualty Care. Wilderness Environ
Med. 2017; 28(2S): S109-S116
40. Franco ME, Otten EJ, Ditzler TF, Compton S,
Hastings PR. Combat and Casualty Care. In: Wilderness
Medicine. edited by Paul S. Auerbach. 6th ed. ELSEVIER MOSBY Philadelphia,
2012. P. 507-523
41. Onifer DJ, McKee JL, Faudree LK, Bennett BL, Miles EA, Jacobsen T, Morey JK, Butler FK Jr. Management of
hemorrhage from craniomaxillofacial injuries and penetrating neck injury in
tactical combat casualty care: iTClamp mechanical wound closure device TCCC
guidelines proposed change 19-04 06 June 2019. J Spec Oper Med. 2019; 19(3): 31-44
42. Sims K, Montgomery HR, Dituro P, Kheirabadi BS, Butler FK. Management of external hemorrhage
in Tactical Combat Casualty Care: the adjunctive use of XStat™ compressed
hemostatic sponges: TCCC Guidelines Change 15-03. J Spec Oper Med. 2016; 16(1): 19-28
43. Callaway DW. Translating Tactical Combat Casualty Care lessons learned to the
high-threat civilian setting: Tactical Emergency Casualty Care and the Hartford
consensus. Wilderness Environ Med.
2017; 28(2S): S140-S145
44. Pennardt A, Kamin R, Llewellyn C, Shapiro G,
Carmona PA, Schwartz RB. Integration of Tactical Emergency Casualty Care (TECC)
into the National Tactical Emergency Medical Services (TEMS) competency
domains. J Spec Oper Med. 2016;
16(2): 62-66
45. Lei R, Swartz MD, Harvin JA, Cotton BA, Holcomb JB, Wade CE, et al. Stop the Bleed Training empowers learners to act to prevent
unnecessary hemorrhagic death. Am J Surg. 2019; 217(2): 368-372
Статистика просмотров
Ссылки
- На текущий момент ссылки отсутствуют.
