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An Inventory of the Combat Medics' Aid

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An Inventory of the Combat Medics' Aid All articles published in the Journal of Special Operations Medicine are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, or otherwise published without the prior written permission of Breakaway Media, LLC. Contact [email protected]. High Reliability. Consistent Performance. An Inventory of the Combat Medics’ Aid Bag Steven G. Schauer, DO, MS1; Jason F. Naylor, PA-C2; Nguvan Uhaa, LPN3; Michael D. April, MD, DPhil, MSc4; Robert A. De Lorenzo, MD, MSM, MSCI5 ABSTRACT Introduction: Tactical Combat Casualty Care (TCCC) recom- Introduction mends life-saving interventions; however, these interventions can only be implemented if military prehospital providers Background carry the necessary equipment to the injured casualty. Combat The TCCC guidelines are a set of evidence-based, prehospital medics primarily use aid bags to transport medical materiels trauma management recommendations specifically designed 1,2 forward on the battlefield. We seek to assess combat medic for the austere, combat setting. Military armed conflict in- materiel preparedness to employ TCCC-recommended inter- troduces numerous factors not encountered in civilian trauma ventions by inventorying active duty, combat medic aid bags. medicine that must inform and influence medical management Methods: We sought combat medics organic to combat arms expectations placed on military prehospital providers, namely units stationed at Joint Base Lewis McChord. Medics volun- combat medics. In particular, “equipment must be simple, light, 3 teered to complete a demographic worksheet and have the and rugged.” A life-saving intervention may be rendered use- contents of their aid bag photographed and inventoried. We less if it cannot be carried to battlefield casualties and effectively spoke with medic unit leadership prior to their participation administered by combat medics, potentially under hostile fire. and asked that the medics bring their aid bags in the way they would pack for a combat mission. We categorized medic aid Front-line, combat medics have few options to transport med- bag contents in the following manner: (1) hemorrhage con- ical materiel to the point of injury. The primary method uti- trol; (2) airway management; (3) pneumothorax treatment, lized by combat medics are aid bags, or backpacks worn over or (4) volume resuscitation. We compared the items found in the uniform and body armor where size and weight are of the 4 the aid bags against the contemporary TCCC guidelines. Re- utmost importance. Excessive size and weight increase physi- sults: In January 2019, we prospectively inventoried 44 com- cal exertion and limits mobility, especially in hostile situations bat medic aid bags. Most of the medics were male (86%), in where rapid mobility is of the highest importance. The US the grade of E4 (64%), and had no deployment experience Army currently fields the M9 medical bag and several com- (64%). More medics carried a commercial aid bag (55%) than mercial vendors offer variations of aid bags and self-contained used the standard issue M9 medical bag (45%). Overall, the litter kits—in addition to smaller pouches that are worn on most frequently carried medical device was an NPA (93%). the thigh or attached to body armor—that combat medics may 5 Overall, 91% of medics carried at least one limb tourniquet, use. In addition to the size and weight limitations, medics can 2% carried a junctional tourniquet, 31% carried a supraglot- carry only what is logistically available. Multiple, previously tic airway (SGA), 64% carried a cricothyrotomy setup/kit, published military studies attribute medical materiel shortfalls 6–11 75% carried a chest seal, and 75% carried intravenous (IV) to the deployed, medical logistical system. CONSISTENT HEMOSTASIS ACHIEVEMENT IN HUMANS fluid. The most commonly stocked limb tourniquet was the C-A-T (88%), the airway kit was the H&H cricothyrotomy Despite more than two decades of TCCC and numerous pub- Hemostatic dressing with the most kit (38%), the chest injury set were prepackaged needle de- lished studies related to TCCC, there are no published data that peer-reviewed (Military & Civilian) compression kits (81%), and normal saline was the most fre- describe and evaluate the combat medic aid bag and its capac- published clinical literature.4 quently carried fluid (47%). Most medics carried a heating ity to facilitate TCCC-recommended, life-saving interventions. blanket (54%). Conclusions: Most medics carried materiels that address the common causes of preventable death on the Goal of This Investigation See us at SOMSA Booth #1003 battlefield. However, most materiels stowed in aid bags were We seek to assess combat medic materiel preparedness to use TCCC-recommended interventions by inventorying active duty to get the facts. not TCCC-preferred items. Moreover, there was a small subset of medics who were not prepared to handle the major causes combat medic aid bags. of death on the battlefield based on the current state of their aid bag. Methods We sought soldiers with the military occupational specialty KEYWORDS: combat; medic; aid bag; military (MOS) 68W, with or without special skills identifiers, as- signed to a brigade combat team. We asked medics with per- MADE IN THE USA www.QuikClot.com/Military sonal aid bags (i.e., not unit issued) to bring their aid bags for ® *Correspondence to Steven Schauer, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234 or [email protected] Z-Medica 4 Fairfield Boulevard Wallingford CT 06492 USA (877) 750-0504 1MAJ Schauer is with the US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam • • • • • • Houston, TX; Uniformed Services University of the Health Sciences, Bethesda, MD; and 59th Medical Wing, JBSA Lackland, TX. 2LTC Naylor is ©2020 Z-MEDICA, LLC. All rights reserved. PSST-1000_Revised_1 with Madigan Army Medical Center, Joint Base Lewis McChord, WA. 3Ms Uhaa is with US Army Institute of Surgical Research, JBSA Fort Sam References: Houston, TX. 4MAJ April is with Uniformed Services University of the Health Sciences, Bethesda, MD; and 4th Infantry Division, 2nd Infantry 1. Zietlow JM, Zietlow SP, Morris DS, Berns KS, Jenkins DH. Prehospital Use of Hemostatic Bandages and Tourniquets: Translation From Military Experience to Implementation in Civilian Trauma Care. J 5 Spec Oper Med. 2015 Summer;15(2):48-53. 2. Schauer SG, April MD, Naylor JF, Fisher AD, Cunningham CW, Ryan KL, Thomas KC, Brillhart DB, Fernandez JRD, Antonacci MA. QuikClot Combat Gauze® Brigade Combat Team, Fort Carson, CO. Dr De Lorenzo is with University of Texas Health–San Antonio, San Antonio, TX. Use by Ground Forces in Afghanistan The Prehospital Trauma Registry Experience. J Spec Oper Med. Summer 2017;17(2):101-106. 3. Shina A1, Lipsky AM, Nadler R, Levi M, Benov A, Ran Y, Yitzhak A, Glassberg E. Prehospital use of hemostatic dressings by the Israel Defense Forces Medical Corps: A case series of 122 patients. J Trauma Acute Care Surg. 2015 Oct;79 (4 Suppl 2):S204-9. 4. Boulton AJ, Lewis CT, Naumann DN, Midwinter MJ. Prehospital haemostatic dressings for trauma: a systematic review. Emerg Med J. 2018; 35: 449-457. 61 All articles published in the Journal of Special Operations Medicine are protected by United States copyright law and may not be reproduced, distributed, transmitted, displayed, or otherwise published without the prior written permission of Breakaway Media, LLC. Contact [email protected]. equipment inventorying. Before participating, we contacted TABLE 1 Demographics of Medics With Aid Bags Inventoried* relevant unit leadership and asked that the medics bring their % (n) or Median (IQR) aid bags in the way they would pack for a combat mission Age, y 23 (31–29) Demographics (without medications). Sex, male 86% (32) E2 5% (2) Ethics E3 5% (2) We submitted project proposal H-18-035 to the US Army In- stitute of Surgical Research (USAISR) regulatory support di- Rank E4 64% (24) vision. Our project met all USAISR regulatory requirements E5 21% (8) for performance improvement not requiring institutional re- E6 3% (1) view board oversight. Participants volunteered to complete None 75% (28) Deployment the aid bag inventory and associated survey. Additionally, we 1 18% (7) experience obtained approval to inventory and photograph aid bags from 2 5% (2) the relevant chain of command. *We were unable to link seven aid bags to surveys for demographic information. Surveys We prospectively administered surveys to combat medics. Sur- materiel to address the most common preventable causes of veys solicited data on each subject’s demographics and prior death on the battlefield (Table 2). However, few of the specific operational experience. The surveys also solicited data regard- devices carried were preferred by TCCC. More medics used ing the contents of each subjects’ aid bag (see the Survey online a commercial, nonstandard aid bag than used the unit- issued at https://jsom.us/SchauerSurvey). M9 medical bag. More concerning is that 9% of medics did not have any limb tourniquets, 98% did not have a junctional TCCC Guidelines and Lifesaving Interventions tourniquet, 69% did not have an SGA, 36% did not have a We categorized medic aid bag contents according to the cat- cricothyrotomy setup, 25% did not have a chest seal, and 25% egory of life-saving intervention facilitated by each piece of did not have any IV fluids. Ostensibly, these medics are not equipment: (1) hemorrhage control;
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