Respectfully,

Michelle DuGuay Landers, MBA, BSN, RN

Breakaway Media, LLC

Publisher

Journal of Special Operations Medicine (JSOM)

Lt Col, USAF/NC (Ret)

publisher@jsomonline.org

www.JSOMonline.org

Purchase our Handbooks

ABSTRACT

Background: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. Assessing outcomes associated with airway interventions is important, and temporal trends can reflect the influence of training, technology, the system of care, and other factors. We assessed mortality among casualties undergoing prehospital airway intervention occurring over the course of combat operations during 2007-2019. Methods: This is a retrospective analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR). We included only casualties with documented placement of an endotracheal tube, cricothyrotomy, or supraglottic airway (SGA) in the prehospital setting. Results: Within the DODTR from January 2007 to December 2019, there were 25,849 adult encounters with documentation of any prehospital activity. Within that group, there were 251 documented cricothyrotomies, 1,147 documented intubations, and 35 documented supraglottic airways placed. Cricothyrotomy recipients had a median age of 25. Within this group, the largest proportion were non-North Atlantic Treaty Organization (NATO) military personnel (35%), were injured by explosives (54%), had a median injury severity score (ISS) of 24, and 60% survived to hospital discharge. Intubation recipients had a median age of 24. Within this group, the largest proportion were non-NATO military personnel (37%), were injured by explosives (57%), had a median ISS of 18, and 76% survived to hospital discharge. SGA recipients had a median age of 28.

ABSTRACT

Medical leadership must decide how prehospital airways will be managed in a combat environment, and airway skills can be complicated and difficult to learn. Evidence informed airway strategies are essential. A search was conducted in Medline and EMBASE databases for prehospital combat airway use. The primary data of interest was what type of airway was used. Other data reviewed included: who performed the intervention and the success rate of the intervention. The search strategy produced 2,624 results, of which 18 were included in the final analysis. Endotracheal intubation, cricothyroidotomy, supraglottic airways, and nasopharyngeal airways have all been used in the prehospital combat environment. This review summarizes the entirety of the available combat literature such that commanders may make an evidence-based informed decision with respect to their airway management policies.



ABSTRACT

Background: Exsanguination is the leading cause of preventable posttraumatic death, especially in the prehospital arena. Traditional hemorrhage control methods involve packing the wound with hemostatic agents, providing manual pressure, and then applying a pressure dressing to stabilize the treatment. This is a lengthy process that frequently destabilizes upon patient transport. Conversely, the iTClamp, a compact wound closure device, is designed to rapidly seal wound edges mechanically, expediting clot formation at the site of injury. Objectives: To determine the efficacy of the iTClamp with and without wound packing in the control of a lethal junction hemorrhage. Methods: Given the limited available information regarding the efficacy of the iTClamp in conjunction with traditional hemostatic agents, this study used a swine model of severe junctional hemorrhage. The goal was to compare a multiagent strategy using the iTClamp in conjunction with XSTAT to the traditional method of Combat Gauze packing with pressure dressing application. Readouts include application time, blood loss, and rebleed occurrence. Results: Mean application times of the iTClamp treatment alone or in conjunction with other hemostatic agents were at least 75% faster than the application time of Combat Gauze with pressure dressing. Percent blood loss was not significantly different between groups but trended the highest for Combat Gauze treated swine, followed by iTClamp plus XSTAT, iTClamp alone and finally iTClamp plus Combat Gauze. Conclusion: The results from this study demonstrate that the iTClamp can be effectively utilized in conjunction with hemostatic packing to control junctional hemorrhages.

Keywords: iTClamp; hemorrhage; trauma; junctional wounds; hemostatic agent

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field.

Current Episode

The Winter 2022 episode of the JSOM podcast is our most recent recording and is now available on our website and wherever you listen to podcasts.

Our guest medic editor this quarter is Devin DeFeo, a former SOF medic. 2LT DeFeo enlisted in the Army in 2004 and served as an 18D with 1SFG(A) and USASOC. As a medic, he authored the concept for MARCHE2 for TCCC in the chemical, biological, radiological, and nuclear (CBRN) environment published in JSOM, which later formed the framework for the Joint Trauma System Clinical Practice Guidelines on CBRN medicine and the CBRN chapter in the Ranger Medical Handbook. He then participated in the Enlisted to Medical Degree Preparatory Program (EMDP2) at George Mason University, earning a master of science in biology. He is currently a third-year medical student at the Uniformed Services University of the Health Sciences (USUHS). 2LT DeFeo is considering a residency in emergency medicine. He will be reviewing Does Mental and Visual Skills Training Improve High-Value Target Identification and Marksmanship Among Elite Soldiers? by J. Jay Dawes, et al. (p. 22). Our author interview is with Michael J. Egnoto, PhD (An Exploratory Comparison of Water-Tamped and -Untamped Explosive Breaches: Practical Applications for the Tactical Community via Pilot Study). Dr Egnoto is affiliated with the Walter Reed Army Institute of Research, Forest Glen Annex, Silver Spring, MD.

The Journal of Special Operations Medicine is proud to have the support of many great sponsors and media partners. Our sponsors are leaders in the field of military medical technology. Please help support these companies by following the links below to learn more about their missions and the products they offer. This section also features peridoic promtional information for events and conferences, including the 2023 SOMA Scientific Assembly. 

The JSOM is incredibly grateful to have the support of many institutions around the world. We would like to thank our recent institutional subscribers and re-subscribers for their support by acknowledging them in our eNewsletter and, when applicable, sharing their social media information.

Visit https://jsom.us/Library for a full list of institutions currently subscribing to the JSOM. We are beginning a campaign to expand our institutional subscriptions. If you think your company would benefit from an institutional subscription, let us know! We'll be happy to talk to you and get the ball rolling. You don't have to be a university or medical center to subscribe - we have many EMS units, government agencies, and military medical units in the United States and abroad.

Are you on the list? Great! Need to know how to access our resources? You can either contact your head librarian or shoot an email to subscriptions@JSOMonline.org.

Institutions receive a print copy of our journal, digital access, or both. Digital subscribers have unlimited access to our full compendium of articles, journals, and the ATP-P. If you are a student, researcher, doctor, or other medical professionals at one of these institutions, please contact your librarian for login details. Additionally, the digital resources are typically available 2-3 weeks ahead of print publication.

If your institution is not on the list and you want more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.

For over 20 years, the Journal of Special Operations Medicine (JSOM) has brought important, lifesaving information to the Special Operations Forces (SOF) community. And over the years, as our audience and readership has expanded into over 80 countries, physicians, military and tactical medics, and other medical professionals working in unconventional environments rely on the JSOM for breakthrough research at the intersection of operational medicine and tactical casualty care. Our peer-reviewed research and interactive clinical content make the JSOM a must-read for:

• Physicians
• Medics
• Educators
• Law Enforcement
• The military and civilian global medical community

For these reasons, many of the world’s top medical technology companies and medical device distributors make the JSOM a cornerstone of their advertising programs. And with a strong multichannel and social media presence, the JSOM offers the most dynamic print and digital media options at cost-effective prices. For medical marketers worldwide looking to reach our niche audience, the JSOM is the gold standard. For more information, please see our attached media kit.

CAMP PENDLETON, CA

Photo by Cpl. Willow Marshall 

1st Marine Division

DVIDS

U.S. Navy corpsmen with 1st Marine Regiment, 1st Marine Division, run with a simulated casualty during the annual Corpsman Cup at Marine Corps Base Camp Pendleton, California, March 30, 2023. The Corpsman Cup is a long-standing tradition within 1st MARDIV. This year the Corpsman Cup was modified to honor the 78th anniversary of the Battle of Iwo Jima and Petty Officer 2nd Class George E. Wahlen, a corpsman who earned the Medal of Honor after being wounded multiple times during the battle but refusing to evacuate so he could attend to injured Marines.

Do You Have a Photo to Share?  

Please send us your approved medical action images for future covers, our journal Photo Gallery, bi-weekly eNewsletters, and JSOM social media! All images must include captions in the emails in which they are sent. Images for print must be high resolution, at least 300 dpi. Images for the eNewsletter and social media must be at least 400px wide, 72 dpi.