ABSTRACT

Background: The Tactical Pneumatic Tournqiuet 2" (TPT2, 5.1cm-wide deflated) allows total average applied pressure measurement, which should be useful toward development of emergency-use limb tourniquet certification devices. Methods: The TPT2 hand bulb was replaced with stopcocks and syringes, allowing filling with continuous pressure measurement. Forearm and mid-thigh applications involved two sets of five Doppler-based pulse gone/return pairs. Second set pulse gones were chosen a priori for occlusion pressures (preliminary work indicated greater consistency in second sets). Results: All 68 forearms occluded (30 female, 38 male, median circumference 17.8cm, range 14.6-23.5cm; median second set of pulse gone tourniquet pressures 176mmHg, range 128-282mmHg). Fifty-five thighs occluded (median circumference 54.3cm, range 41.6-62.4cm; median systolic pressure 126mmHg, range 102-142mmHg; median second set of pulse gone pressures 574mmHg, range 274-1158mmHg). Thirteen thigh applications were stopped without occlusion because of concerning pressures combined with no indication of imminent occlusion and difficulties forcing more air into the TPT2 (3 female, 10 male, peak pressures from 958-1377mmHg, median 1220mmHg, p<.0001 versus occluded thighs; median circumference 63.3cm, range 55.0-72.9cm, p<.0001 versus occluded thighs; median systolic pressure 126mmHg, range 120-173mmHg, p<.019 versus occluded thighs). Thigh TPT2 impression widths on five subjects after occlusion were as follows: 3.5cm, occlusion 274mmHg; 2.8cm, occlusion 348mmHg; 2.9cm, occlusion 500mmHg; 2.8cm, occlusion 782mmHg; 2.7cm, occlusion 1114mmHg. Conclusions: Though probably useful to tourniquet certification, the required pressures for thigh occlusion make the TPT2 undesirable for any clinical use, emergency or otherwise.

Life Over Limb: Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine

Patterson J, Bryan RT, Turconi M, Leiner A, Plackett TP, Rhodes LL, Sciulli L, Donnelly S, Reynolds CW, Leanza J, Fisher AD, Kushnir T, Artemenko V, Ward KR, Holcomb JB, Schmitzberger FF.

24(1). 18 - 25. (Journal Article)

ABSTRACT

The use of tourniquets for life-threatening limb hemorrhage is standard of care in military and civilian medicine. The United States (U.S.) Department of Defense (DoD) Committee on Tactical Combat Casualty Care (CoTCCC) guidelines, as part of the Joint Trauma System, support the application of tourniquets within a structured system reliant on highly trained medics and expeditious evacuation. Current practices by entities such as the DoD and North Atlantic Treaty Organization (NATO) are supported by evidence collected in counter-insurgency operations and other conflicts in which transport times to care rarely went beyond one hour, and casualty rates and tactical situations rarely exceeded capabilities. Tourniquets cause complications when misused or utilized for prolonged durations, and in near-peer or peer-peer conflicts, contested airspace and the impact of high-attrition warfare may increase time to definitive care and limit training resources. We present a series of cases from the war in Ukraine that suggest tourniquet practices are contributing to complications such as limb amputation, overall morbidity and mortality, and increased burden on the medical system. We discuss factors that contribute to this phenomenon and propose interventions for use in current and future similar contexts, with the ultimate goal of reducing morbidity and mortality.

ABSTRACT

Military working canines are critical assets and force multipliers for the Joint Force. Most often deployed forward of Role 2 assets, they are reliant on non-veterinary resources when wounded, ill, or injured in an operational environment. Hemorrhagic shock is the most prevalent form of shock seen in battlefield injuries and is most effectively treated with whole blood transfusion. Dogs cannot be transfused with human blood and there is no formal Department of Defense (DoD) canine blood product distribution system to operational settings. A walking blood bank is helpful when multiple dogs are geographically co-located and the resource can be provided to an injured patient quickly. In areas as widely dispersed as the Horn of Africa, the likelihood of co-location is slim and delaying this vital resource can mean the difference between life and death. Therefore, personnel at the Role 2 facility in Camp Lemonnier, Djibouti, filled a critical capability gap for the operational area by producing a local canine whole blood bank with distribution to multiple countries. This protocol can be replicated by other locations to improve medical readiness for the working canines who serve to maintain DoD Force Protection.

Keywords: military working dogs; whole blood transfusion; transfusion medicine; veterinary medicine



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. The Winter 23 episode is here!

Current Episode

Our JSOM podcast team will be reviewing the following articles for our Winter podcast: 

Optimizing Brain Health of United States Special Operations Forces by Brian L. Edlow, Natalie Gilmore, Samatha L. Tromly, et al. 

Bluetooth Tactical Headsets Improve the Speed of Accurate Patient Handoffs by Daniel J. Stinner, Cory McEvoy, Michael A. Broussard, et al.

Effectiveness of Sternal Intraosseous Device in Patients Presenting with Circulatory Shock: A Retrospective Observational Study by Allyson M. Hynes, Shyam Murali, Gary A. Bass, et al. 

JSOM Guest Medic Interview

Our guest medic for this quarter is Ricky Ditzel, who will review “Optimizing Brain Health of United States Special Operations Forces” by Edlow and colleagues. Ricky and his two siblings’ adolescent lives were defined by chaos. Inspired to make a positive change for his family, he enlisted in the Army and served as a U.S. Army Special Operations Flight Paramedic. In this role, Ricky treated U.S. and Allied forces Servicemembers who suffered from the acute and chronic effects of traumatic brain injury. These experiences propelled Ricky to become a neurodegenerative disease researcher and vocal advocate for brain and mental health. Ricky believes strongly in a life of service and consistently seeks opportunities to support underserved communities and promote health equity. He believes the current healthcare structure reduces access to care for individuals with neurologic disabilities because of limitations associated with public transportation, specialty care access, and education. Driven towards research and finding solutions to increase the quality of life for people with neurological disabilities, Ricky is pursuing a career as a physician. He plans to create a neurologic center of excellence that will provide comprehensive multidisciplinary outpatient care under one roof. Ricky is the Chairman of the Special Operations Forces to School of Medicine (SOF to SOM) (https://www.softosom.org/), a board member of Neuroacanthocytosis Advocacy USA, and the Special Operations Medical Association. He will continue to serve his country and community while doing his best to honor the legacies of those who have gone before him. “For they loved to fight, fought to win, and would rather die than quit. Night Stalkers don’t quit!”

JSOM Guest Author Interview

Our guest author interview will be with Cory McEvoy, author of “Bluetooth Tactical Headsets Improve the Speed of Accurate Patient Handoffs.” Cory is a former 18D who served with 1-1SFG(A) and USASOC. Cory has deployed to both humanitarian and combat zones as an 18D and has been involved with many research projects, with his primary interest being repetitive and low-level blast. Cory left the Army in 2023 and is in the process of applying to medical school.

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 2024 SOMA Scientific Assembly. 

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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
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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.

Coming Soon from the Journal of Special Operations Medicine published by Breakaway Media, LLC

We are excited to announce the upcoming publication of Tell Them Yourself: It's Not Your Day To Die*, by Frank Butler, Kevin O'Connor, and Jeff Butler.

It's an extraordinary, true account of how a small group of world-class trauma experts joined forces with America’s best combat medics to rewrite the battlefield medicine rule book and then sell these revolutionary new concepts to a disbelieving medical world.

This is the definitive record of how TCCC came to be and how these protocols forever changed the way care is provided to those wounded in combat, written by the men who fought for the change.

*This highly anticipated book will premiere at the 2024 Special Operations Medical Association symposium. Dr. Frank Butler will be at the JSOM booth signing copies. The book will then be available to purchase on the JSOM website on or around May 20th.



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