Techniques for immobilization and extrication of the patient with a real or potential spine injury have been implemented for decades, albeit without high-quality evidence supporting their use.

Such techniques addressed well-intentioned concerns about inflicting further serious injury. However, there is little evidence to support the effectiveness or necessity of these techniques, and increasing evidence suggests that such interventions may be harmful.

Historic principles of out-of-hospital spinal injury care have been more influenced by medicolegal implications and untested theory than by clinical or scientific evidence

Hemorrhage is one of the leading causes of death in trauma victims. Historically, paramedics have not had access to medications that specifically target the reversal of trauma-induced coagulopathies. The California Prehospital Antifibrinolytic Therapy (Cal-PAT) study seeks to evaluate the safety and efficacy of tranexamic acid (TXA) use in the civilian prehospital setting in cases of traumatic hemorrhagic shock.

Preparation for mass casualty incidents (MCI) is obligatory, involving such methods as multiagency tabletop exercises, mock hospital exercises, as well as simulation and training for clinicians in managing the injuries that would be anticipated in such an event.

Even in the best prepared units, such an incident will pose significant challenges due to the unpredictable nature of these events with respect to timing and number of casualties

Tranexamic acid (Cyklokapron) for intravenous use is supplied in 1-gram/100 ml ampules and vials (stoppered vials are preferred for prehospital use). When used for the treatment of severe hemorrhage in adults, the usual dose is a 1-gram loading dose administered intravenously over 10 minutes, followed by a second 1-gram dose infused intravenously over eight hours (for pediatrics, consider 10 mg/kg IV). When administered out of hospital, most instances will require administration of only the loading dose. This medication is most effective when initiated close to the time of wounding and is shown to reduce mortality when given within the first three hours following injury.

Introduction: Identifying patients at imminent risk of death is a paramount priority in combat casualty care. This study measures the vital sign values predictive of mortality among combat casualties in Iraq and Afghanistan.

Methods: We used data from the Department of Defense Trauma Registry from January 2007 to August 2016. We used the highest documented heart rate and the lowest documented systolic pressure in the emergency department for each casualty. We constructed receiver operator curves (ROCs) to assess the accuracy of these variables for predicting survival to hospital discharge.

Results: There were 38,769 encounters of which our dataset included 15,540 (40.1%). The median age of these patients was 25 years and 97.5% were male. The most common mechanisms of injury were explosives (n = 9481,
61.0%) followed by gunshot wounds (n = 2393, 15.3%). The survival rate to hospital discharge was 97.5%. The median heart rate was 94 beats per minute (bpm) with area under the ROC of 0.631 with an optimal threshold to predict mortality of 110 bpm (sensitivity 52.2%, specificity 79.2%). The median systolic blood pressure was 128 mmHg with area under the ROC of 0.790 with an optimal threshold to predict mortality of 112 mmHg (sensitivity 68.5%, specificity 81.5%).

Conclusions: Casualties with a systolic blood pressure b112 mmHg, are at high risk of mortality, a value significantly higher than the traditional 90 mmHg threshold. Our dataset highlights the need for better methods to guide resuscitation as vital sign measurements have limited accuracy in predicting mortality.

The Advanced Resuscitative Care (ARC) CPG is the most advanced TCCC update yet. For those who have been paying attention, it marks a milestone in DoD medicine, by allowing advanced providers with a mastery of the basics to reach into the remaining cause of preventable death: Noncompressible Torso Hemorrhage, or NCTH.

 

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