DOCSLIB.ORG

The War in Afghanistan: War As a Labortory for Trauma Research

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The War in Afghanistan: War As a Labortory for Trauma Research THE WAR IN AFGHANISTAN | NEWSFOCUS From soldier to subject. Researchers are collecting data from casualties like this one in Afghanistan. Downloaded from http://science.sciencemag.org/ personnel, they come with exhaustive data relating to preinjury health and postinjury on October 16, 2017 War as a Laboratory outcome. Many of the insights gained from battlefi eld studies have found their way into For Trauma Research civilian emergency medicine. But war is also the most chaotic and stressful environment The military is sending scientists onto the battlefi eld to fi nd ways to improve imaginable for doing science. “Someone has emergency medicine, but the research faces a practical and ethical minefi eld to take down all this data,” Osborne says. “I saw this poor girl trying to turn this blood- KANDAHAR AIRFIELD, AFGHANISTAN— question.” What saved him was a series of smeared page, trying to get data off of it. … Easing back into a borrowed chair in a tiny extremely rapid interventions, including new That’s the reality. Until you’ve lived that, you trailer office here on the base, Cmdr. Lisa techniques for applying tourniquets, drugs, don’t realize how diffi cult it is.” Osborne should be enjoying a moment of and blood products. Those insights came Adding to the diffi culty, controversy has calm. But all she can talk about is work. “I saw from medical research conducted in Iraq and dogged JC2RT projects, including charges a guy show up here in trauma. You wouldn’t Afghanistan, orchestrated through a U.S. mili- by journalists that researchers rushed experi- believe the condition he was in,” she says, tary program called the Joint Combat Casu- mental treatments onto the battlefi eld without recalling the victim of an improvised explo- alty Research Team (JC2RT). As its deputy proper ethical review or suffi cient safety test- sive device (IED). The extent of the injuries director, Osborne runs the show. ing, needlessly risking the lives of soldiers. was shocking, even to the hardened medics In many ways, war is the perfect labora- Science investigated these issues with the help working here in Afghanistan. “He was miss- tory for trauma medicine research. On any of two bioethicists and several sources from ing both legs and his whole backside. But he given day, dozens or even hundreds of casu- both civilian and military trauma medicine. was alive, breathing on his own.” alties arrive by helicopter to military hospi- For most people, a scene like that would tals across Afghanistan. IEDs are the num- Exploring the golden hour fill them with nothing but horror. But for ber one risk, often combining burns, deep From the moment a bullet or piece of shrap- Osborne, a U.S. Navy anesthesiologist and lacerations from shrapnel, and brain trauma nel hits the body, the clock is ticking. Trauma medical researcher, it was a reminder of from blast waves. Injuries like these are too medics call it the “golden hour,” the small hard-earned progress. “Years ago, that kind rare to study in peacetime. And because window of time in which the patient’s life CREDIT: AP CREDIT: of patient would be dead,” she says. “No all the patients in these studies are military can be saved. Death can come in a mat- www.sciencemag.org SCIENCE VOL 331 11 MARCH 2011 1261 Published by AAAS NEWSFOCUS ter of minutes, hours, or days, but the most components—plasma containing platelets crucial interventions must be made imme- and clotting factors—added sparingly later. diately. War has been “an amazing learning “What we realized,” says Osborne, “is that environment,” says Osborne, with each con- if you wait on those clotting factors, then fl ict pushing trauma medicine forward. New you’re always behind. You can keep putting motorized ambulances in World War I saved in red blood cells and they just keep pouring wounded soldiers by getting them from the right out [of the wounds].” The transfusion front lines to the hospitals quickly. World protocol for severe injuries has now been War II saw the fi rst large-scale use of anti- revamped based on JC2RT research. For biotics. Medics in the Korean War pioneered injuries that require massive transfusions, repair and grafting techniques for vascular the equivalent of whole blood is now given surgery. In the Vietnam War, portable radi- immediately, including a full complement of ology equipment and ventilators were tested clotting factors. The researchers found that it in the fi eld. reduced mortality rates in these patients from With the wars in Afghanistan and Iraq, 65% to 17%. combat medicine has faced a new prob- Another dramatic change from JC2RT lem. “The diffi culty for the current genera- research is how “damage control” surgery is tion is getting approval for research,” says performed. “We found that it’s critical that we Col. Martin Bricknell, a senior doctor in the Whole blood. These empty transfusion bags from not close some injuries when they come in Downloaded from U.K. Royal Army Medical Corps who hosted a single patient in Afghanistan show the 1-to-1 here,” Osborne says, “because the outcomes this reporter’s visit to military facilities in ratio of blood products now used. are massive infections and sepsis.” Instead, Kandahar (see p. 1256). “It is considerably blood vessels are tied off and the wound is left more rigorous than it used to be, and there- Once a research project passes this pre- open, sometimes for several days, vigorously fore the lag between good idea to outcomes is screening, it must be approved by an inde- cleaning it with saline. “We used to close that much greater.” JC2RT was created in 2006 to pendent U.S. Army institutional review board wound 7 years ago,” she says. http://science.sciencemag.org/ streamline that process. (IRB) based at Fort Detrick, Maryland. That Other problems have yet to be solved. “We’re a team of eight,” says Osborne, review process is identical to those at any One of the most urgent is compartment syn- a petite, blonde 42-year-old in the middle research institution, Osborne says, sourc- drome, the accumulation of fl uid between of her 6-month tour of duty in Afghanistan. ing outside experts as needed. Osborne and tissue layers that can result in amputation When she is not at war, Osborne is the direc- her colleagues identify issues likely to cause or even death if the pressure cuts off blood tor of anesthesiology research at the Uni- problems with reviewers, giving researchers to organs. One JC2RT project is testing formed Services University of the Health a chance to address them early “so that when whether the pressure in an injured limb can Sciences in Bethesda, Maryland. “Most of [the proposal] goes to IRB it has a chance,” be diagnosed earlier by detecting a drop in us have Ph.D.s,” she says, “but we’re not data Osborne says. At least one of the investigators oxygen in the tissue. Another unsolved prob- collectors.” Instead, JC2RT is a gatekeeper must be present to undertake the study in the lem explored by JC2RT projects is how to on October 16, 2017 and overseer. Ideas for projects are put for- fi eld. “Most of these folks, they’re only here diagnose brain trauma, for example, using ward by researchers from all branches of the for a short amount of time. If their stuff gets ultrasound to measure the blood pressure of U.S. military, often with university-based held up in IRB for 6 months, they miss the vessels within the eye. scientifi c partners. As the proposals roll in, boat. We try to prevent that from happening. Because of the streamlined process, Osborne says, “I’m the one who has to give But it does happen.” insights from those projects will move quickly people the bad news that their research proj- To date, about 100 projects have made it onto the battlefi eld. In medical research, says ect isn’t going to work.” through this gauntlet and into the fi eld, so far Osborne, “you normally have a 10-year pipe- A typical problem is feasibility. “The producing dozens of peer-reviewed research line” between the fi rst experiment and a new people who are writing these [proposals] papers (see table on p. 1263). All of them take treatment for patients. “For us, it can be half are just coming into theater,” Osborne says. advantage of data from the U.S. military’s a year,” she says. “They don’t realize that there’s no way they’re Joint Theater Trauma Registry (JTTR), a The speedy turnaround has doubtless going to be able to do it.” As an example, she continuously updated record of trauma cases saved lives. But at the same time, it has describes a project that would have required in Iraq and Afghanistan. JTTR currently con- invited intense scrutiny. infrared photography of injured soldiers’ tains the case histories of 40,000 patients, limbs. “You often have a whole sea of people including medical observations, treatments, Serious charges working on the patient. You can’t tell them, and outcomes in minute detail. Most of the Wartime medical research has a troubled his- ‘Okay, everybody step back. I’m going to research has yielded incremental improve- tory. The most notorious examples are the snap some photos.’ ” ments to existing treatments. But some have experiments performed on prisoners by Ger- Another fatal fl aw is the use of experi- overturned paradigms of trauma care, says man and Japanese doctors during World War mental medical devices. “It’s a deal-breaker,” Osborne. One example is blood transfusion.
Load more

Recommended publications
  • Tourniquet Use in Out-Of-Hospital Emergency Care: a Systematic Review
    Emergencias 2019;31:47-54 REVIEW ARTICLE Tourniquet use in out-of-hospital emergency care: a systematic review Mara Alonso-Algarabel 1, Xavier Esteban-Sebastià 2, Azucena Santillán-García 3, Rafael Vila-Candel 4,5 Objective. Uncontrolled bleeding from serious injuries continues to be one of the main causes of preventable deaths Author affiliation: 1Surgery Unit and Outpatient, outside hospitals. Tourniquets could be useful for quickly stemming blood flow and prevent exsanguination, although Hospital Universitario Miguel evidence supporting their use and effectiveness in civilian accidents is limited. To analyze the effectiveness of tourni - Servet, Zaragoza, Spain. quets for stopping bleeding in out-of-hospital emergencies and to explore factors associated with effectiveness. 2Emergency Department, Hospital Comarcal Vinarós, Castellón, Methods. We undertook a systematic review of the literature in Spanish and English. Search protocols to identify Spain 3 studies that evaluated the use of various devices and their effectiveness in stemming arterial blood flow. We included Cardiology Department, Hospital Universitario de Burgos, Burgos, studies published between 2011 and 2016 in which tourniquets were used to prevent massive blood loss. Spain 4Department of Obstetrics and Results. We included 17 articles. Tourniquets were effective in stopping massive bleeding in all studies. Pain, the most Gynecology, Hospital Universitario frequently described adverse effect, was observed in 420 patients (35.7%). Delayed application of a tourniquet was de la Ribera, Alzira, Valencia, associated with more negative outcomes. Spain. 5Nursing Department, Conclusions. Tourniquets are effective for stopping massive blood loss. There are few complications, most of which are Universidad Católica de Valencia attributable to the critical state of patients rather than to application of the tourniquet.
    [Show full text]
  • 2018 Arkansas Minimum Pre-Hospital Clinical Guidelines
    2018 Arkansas Minimum Pre-hospital Clinical Guidelines These guidelines were developed by the Medical Directors Council of the National Association of State EMS Officials (NASEMSO). These guidelines were then reviewed by the Arkansas Core Medical Directors Committee to address Arkansas specific guidelines. These guidelines will be maintained by both NASEMSO and the Arkansas Core Medical Directors to address updates in clinical guidelines, protocols or operating procedures. Arkansas medical directors and encouraged to use the guidelines at their discretion. These guidelines are considered the minimum guidelines that all EMS Agencies should adopt. EMS Agencies clinical guidelines, protocols or operating procedures should at a minimum meet these guidelines. These guidelines are either evidence-based or consensus-based and have been formatted for use by field EMS professionals. Arkansas Updated May 2018 2 National Model EMS Clinical Guidelines VERSION 2.0 Contents INTRODUCTION .................................................................................................................................6 PURPOSE AND NOTES ........................................................................................................................7 TARGET AUDIENCE ......................................................................................................................................... 8 NEW IN THE 2017 EDITION ............................................................................................................................
    [Show full text]
  • Prehospital Assessment of Trauma
    Prehospital Assessment of Trauma a b c, Joshua Brown, MD, MSc , Nitin Sajankila, BS , Jeffrey A. Claridge, MD, MS * KEYWORDS Prehospital Emergency medical services Trauma Triage Air medical Transport KEY POINTS A significant amount of variability exists between the various prehospital trauma systems that provide early postinjury care in the United States. This variability includes differences in emergency medical services provided, types of transport available, protocols guiding care, and cooperation between hospitals and pro- viders involved. Although advances have been made to prehospital care, more research is necessary to see how uniformly these advances are implemented. Further research on determining the best care practices and the development of uniform protocols is also necessary. INTRODUCTION AND HISTORY OF PREHOSPITAL TRAUMA CARE As with many of the advancements in trauma care, prehospital trauma care has evolved significantly with periods of military conflict. Most credit Baron Dominique Jean Larrey, Napoleon’s surgeon, with the concept of the ambulance in 1792.1 The genesis of an organized ambulance corps in the military, however, was not until the United States Civil War. This experience was furthered in World War II, when medical personnel were assigned to combat companies to provide care at the point of wound- ing, becoming the first combat medics. It was then during the Korean War and Vietnam conflict that en route care by medics for the wounded solider became the standard, alongside the rapid transport of patients
    [Show full text]
  • Wound Care Management During a Mass Casualty Emergency: an Evidence-Based Approach for Triage, Tourniquets, Wound Packing, and Chest Seals
    Wound Care Management during a Mass Casualty Emergency: An Evidence-Based Approach for Triage, Tourniquets, Wound Packing, and Chest Seals The Athletic Trainers Ability to think beyond the basics On Field or Off, you may face the event Introductions • Mr. Edward Strapp, TP-C/FP-C, NRP, ATC – Trooper/Flight Paramedic, Maryland State Police – Rotational Athletic Trainer, US Ski and Snowboard Provider Disclaimer • In compliance with continuing education requirements, all presenters must disclose any financial associations with the manufacturers of commercial products, supplies of commercial services, or commercial supporters as well as any use of unlabeled product(s) or product(s) under investigational use. • Event committee, and the presenters for this seminar do not have financial or other associations with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. • This presentation does not involve the unlabeled use of a product or product under investigational use. • There was no commercial support for this activity. ***Warning*** Some pictures may be graphic in nature. Presenter Conflict • No Conflict • The views expressed in these slides and the today’s discussion are ours • Our views may not be the same as the views of our company’s clients or our colleagues • Participants must use discretion when using the information contained in this presentation Learning Objectives • Understand the need for the rapid identification and management of gross bleeding in the trauma patient. • Identify the phases of shock and the physiological changes. • Identify the rationale for the application of different advanced wound care interventions. Learning Objectives • Acquire the skills needed for tourniquet and wound packing interventions.
    [Show full text]
  • Prolonged Prehospital Tourniquet Placement Associated with Severe Complications: a Case Report
    CASE REPORTS RAPPORT DE CAS Prolonged prehospital tourniquet placement associated with severe complications: a case report Christian Malo, MD, MSc*†; Bruno Bernardin, MD*; Joe Nemeth, MD*; Kosar Khwaja, MD, MBA† Keywords: Tourniquet, Prehospital, Extremity Injury, beats/min). Because no blood products were available, Ischemia, Hemorrhage, Gunshot Wounds the patient was administered crystalloids. At 10:20 pm, the trauma team leader at our institution was contacted by INTRODUCTION the local physician in the closest village, and, at 2:30 am, the local physician had arrived at the patient’sbedside Emergency tourniquet application to arrest hemorrhage with blood products. Due to continued hemodynamic in major limb trauma, particularly in the military context, compromise and agitation, the patient was intubated, – has been shown to be a life-saving manoeuvre.1 3 Due to started on a norepinephrine infusion, and administered the potential for significant complications (including five units of packed red blood cells and three units of clots, myonecrosis, pain, palsy, abscess, blisters, contu- fresh frozen plasma. The left lower extremity distal to the sions, abrasions, renal failure, compartment syndrome, tourniquets was reportedly cold, cyanotic, and edematous, and amputation)4 and the paucity of evidence of its role in at this time. The patient responded to fluid resuscitation, the non-military context, controversy persists regarding and the norepinephrine was gradually weaned. tourniquet use. We describe a civilian case in which The patient was transported from the remote village improvised tourniquets were applied to an extremity for to the nearest community hospital, arriving at 6:00 am. 17 hours following a penetrating lower limb injury in a The first venous blood gas measurement showed a pH remote area of Quebec.
    [Show full text]
  • Optimizing the Use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC
    Optimizing the use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02 Stacy A. Shackelford, MD; Frank K. Butler Jr., MD; John F. Kragh Jr., MD; Rom A. Stevens, MD; Jason M. Seery, MD; Donald L. Parsons, PA-C; Harold R. Montgomery, NREMT/ATP; Russ S. Kotwal, MD; Robert L. Mabry, MD; Jeffrey A. Bailey, MD Keywords: Tourniquet, Tactical Combat Casualty Care Guidelines, external hemorrhage control, shock, resuscitation, emergency medical services Proximate Cause for the Proposed Change The early use of limb tourniquets has been documented to save lives on the battlefield, but has the potential for significant morbidity. This change has four goals: 1. Clarification of tourniquet conversion guidelines. Since its inception, Tactical Combat Casualty Care (TCCC) has emphasized the early and liberal use of tourniquets to control life-threatening hemorrhage in the Care Under Fire (CUF) phase. Because evacuation times in Iraq and Afghanistan have been relatively short, the recommendation in the TCCC Guidelines to re-evaluate the need for a tourniquet in the Tactical Field Care (TFC) phase of care and use other means of hemorrhage control has been de-emphasized in practice by users. There is often no attempt to convert tourniquets to hemostatic or pressure dressings because of the short evacuation times in Afghanistan at present. Increasingly, worldwide casualty care scenarios are anticipated to include long-range evacuation. Recent real-world events in theaters other than the Middle East have demonstrated that reinforcement of tourniquet conversion guidelines is needed at this time. 2. Clarification of effective tourniquet placement. Ineffective venous tourniquets have been shown to be a relatively common occurrence that increases blood loss and complications.1-3 Optimal use of limb tourniquets must result in both cessation of bleeding and stoppage of the distal pulses in the extremity.
    [Show full text]
  • Chapter 33 TACTICAL MEDICINE
    Tactical Medicine Chapter 33 TACTICAL MEDICINE LANNY F. LITTLEJOHN, MD,* and BRENDON G. DREW, DO† INTRODUCTION BACKGROUND Tactical Environment History of Combat Death Statistics Wounding Patterns TACTICAL COMBAT CASUALTY CARE OVERVIEW Origins Definitive Proof of Effectiveness Phases of Care Contrast to Civilian Prehospital Care HEMORRHAGE CONTROL Tourniquets Hemostatic Dressings Junctional Hemorrhage AIRWAY MANAGEMENT CHEST TRAUMA DAMAGE CONTROL RESUSCITATION Fresh Whole Blood Stored Constituents of Blood Artificial Colloids Crystalloids Best Strategies for Fluid Resuscitation Emerging Adjuncts to Damage Control Resuscitation MEDICATIONS Tranexamic Acid Pain Control Antibiotics CASE REVIEW CONCLUSION *Commander, Medical Corps, US Navy; Command Surgeon, Naval Special Warfare Development Group, Dam Neck, Virginia Beach, Virginia †Commander, Medical Corps, US Navy; Chairman of Emergency Medicine, Naval Medical Center San Diego, San Diego, California 477 Fundamentals of Military Medicine INTRODUCTION Medical practice in a limited-resource operational such as those delineated in the Tactical Combat Ca- environment frequently differs from “standard” sualty Care (TCCC) guidelines and the Prehospital practice in a fully resourced hospital in the United Trauma Life Support (PHTLS) manual.1 Thorough States. Battlefield trauma care is based partly on appreciation of these concepts is important not only standard US guidelines, such as the Advanced for the practice of individual military medical officers Trauma Life Support (ATLS) course, but also with an (MMOs), but also for MMOs’ oversight and empow- eye toward the unique considerations of a forward erment of further forward deployed providers (eg, deployed environment. This chapter will highlight corpsmen and medics) who provide care close to the important operational medical skills and guidelines, point of injury. BACKGROUND Tactical Environment tions can be expected to eventually fail.
    [Show full text]
  • Survival with Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma
    FEATURE Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma COL John F. Kragh, Jr., MC, USA,* Thomas J. Walters, PhD,* David G. Baer, PhD,* LTC Charles J. Fox, MC, USA,† Charles E. Wade, PhD,* Jose Salinas, PhD,* and COL John B. Holcomb, MC, USA* emorrhage from injured extremities continues to be one of the Objective: The purpose of this study was to determine if emergency tourniquet Hleading sources of preventable death on the battlefield.1–4 Data use saved lives. from recent conflicts involving US military personnel confirmed the Summary Background Data: Tourniquets have been proposed as lifesaving continued importance of improving prehospital hemorrhage con- devices in the current war and are now issued to all soldiers. Few studies, trol.3,5–7 In response, the US Army implemented a design, testing, however, describe their actual use in combat casualties. training, and fielding program for battlefield tourniquets,8–11 result- Methods: A prospective survey of injured who required tourniquets was ing in policy that all military personnel in theater carry tourniquets. performed over 7 months in 2006 (NCT00517166 at ClinicalTrials.gov). As a result of this effort, tourniquets are now common on the Follow-up averaged 28 days. The study was at a combat support hospital in battlefields of Iraq and Afghanistan, both in the hands of medical Baghdad. Among 2838 injured and admitted civilian and military casualties and nonmedical personnel. with major limb trauma, 232 (8%) had 428 tourniquets applied on 309 With the Tactical Combat Casualty Care initiative, the US injured limbs. We looked at emergency tourniquet use, and casualties were military is not alone in establishing procedures and equipment for use evaluated for shock (weak or absent radial pulse) and prehospital versus of tourniquets in the prehospital environment by both medical and emergency department (ED) tourniquet use.
    [Show full text]
  • 2020 International Consensus on First Aid Science with Treatment Recommendations
    Circulation 2020 International Consensus on First Aid Science With Treatment Recommendations ABSTRACT: This is the summary publication of the International Eunice M. Singletary, MD, Liaison Committee on Resuscitation’s 2020 International Consensus Chair on First Aid Science With Treatment Recommendations. It addresses David A. Zideman, LVO, the most recent published evidence reviewed by the First Aid Task QHP(C), MBBS, Vice Force science experts. This summary addresses the topics of first aid Chair methods of glucose administration for hypoglycemia; techniques for Jason C. Bendall, MBBS, cooling of exertional hyperthermia and heatstroke; recognition of MM, PhD acute stroke; the use of supplementary oxygen in acute stroke; early David C. Berry, PhD, MHA or first aid use of aspirin for chest pain; control of life-threatening Vere Borra, PhD Jestin N. Carlson, MD, MS bleeding through the use of tourniquets, hemostatic dressings, direct Pascal Cassan, MD pressure, or pressure devices; the use of a compression wrap for Wei-Tien Chang, MD, PhD Downloaded from http://ahajournals.org by on November 6, 2020 closed extremity joint injuries; and temporary storage of an avulsed Nathan P. Charlton, MD tooth. Additional summaries of scoping reviews are presented for Therese Djärv, MD, PhD the use of a recovery position, recognition of a concussion, and 6 Matthew J. Douma, MSN, other first aid topics. The First Aid Task Force has assessed, discussed, RN and debated the certainty of evidence on the basis of Grading of Jonathan L. Epstein, Recommendations, Assessment, Development, and Evaluation criteria MEMS, NRP and present their consensus treatment recommendations with Natalie A. Hood, MD, evidence-to-decision highlights and identified priority knowledge gaps MBBS for future research.
    [Show full text]
  • V1 DRAFT Pediatric TECC Guidelines
    Tactical Emergency Casualty Care (TECC) Guidelines Pediatric Appendix DIRECT THREAT CARE (DTC) Goals: 1. Accomplish the mission with minimal casualties 2. Prevent any casualty from sustaining additional injuries 3. Keep response team maximally engaged in neutralizing the existing threat (e.g. active shooter, unstable building, confined space HAZMAT, etc.) 4. Minimize public harm Principles: 1. Establish tactical supremacy and defer in depth medical interventions if engaged in ongoing direct threat (e.g. active fire fight, unstable building collapse, dynamic explosive scenario, etc.). 2. Threat mitigation techniques will minimize risk to casualties and the providers. These should include techniques and tools for rapid casualty access and egress. 3. Minimal trauma interventions are warranted. 4. Consider hemorrhage control a. TQ application is the primary “medical” intervention to be considered in Direct Threat Care. b. Consider instructing casualty to apply direct pressure to the wound if no tourniquet available or application is not tactically feasible. 5. Consider quickly placing or directing casualty to be placed in position to protect airway. Guidelines: 1. Mitigate any threat and move to a safer position (e.g. Return fire, utilize less lethal technology, assume an overwhelming force posture, extraction from immediate structural collapse, etc.). 2. Direct the casualty to move to a safer position and apply self aid if able. a. Attention must be paid to the type of instruction that will be presented to this population. b. Use of tactile direction, visual signaling and simple language may improve communication. 3. Casualty Extraction a. If a casualty can move to safety, they should be instructed to do so.
    [Show full text]
  • First Aid: the Forgotten Topic?
    First Aid: The Forgotten Topic? Presented By: Jonathan L. Epstein, MEMS, NRP Richard Bradley, MD, FACEP Conflict of Interest and Disclosures Jonathan L. Epstein: • American Red Cross: Senior Director of Science and Content Development • International Trauma Life Support (ITLS): Chair, Board of Directors. Richard N. Bradley: • University of Texas Health Sciences Center at Houston and McGovern Medical School: Professor of Emergency Medicine and Chief of EMS and Disaster Medicine. • American Red Cross: Scientific Advisory Council - Chair, Resuscitation Subcouncil 2 Today’s Discussion • CPR/AED versus First Aid: Science, Technology and Education • Hemorrhage Control Strategies in the Workplace: Tourniquets and Hemostatic Dressings • Stop the Bleed – The new educational focus for the workplace? 3 Poll Every Where Questions • Take out your mobile device or web based device if you have one available. • Text JONATHANEPST738 to 22333 to join the poll. • or • PollEv.com/jonathanepst738 4 Let’s Get Going… A few questions to learn about you and provoke some thoughts as we get started… 5 First Aid: The Forgotten Topic • Question #1: Tell me about yourselves? What is your primary work role? 6 First Aid: The Forgotten Topic • Question #2: How long has first aid training existed? 7 First Aid: The Forgotten Topic • Question #3: Is CPR a First Aid Skill? 8 First Aid: The Forgotten Topic • Question #4: What % of workplace level (trained lay responders) participated in a first aid only course compared to a CPR only course last year? 9 Deaths in the United
    [Show full text]
  • Hemorrhage Control, a Fundamental Skill: a Review of Direct Pressure, Dressings, Wound Packing and Bandages for Life-Saving
    Hemorrhage control, a fundamental skill: A review of direct pressure, dressings, wound packing and bandages for life-saving By Christopher Picard, CD, BSN, RN, ENC(C) Traumatic hemorrhage is “the leading cause of pre- 2014), but neither offer evidence or rational for the recommen- ventable death” among trauma patients (Spahn et al., dations. A meta-analysis of angiography hemostat devices may offer the best evidence for minimum pressure time, concluding 2013), causing 40% of all mortality (Curry et al., 2011). that hemostatic devices have the best time to hemostasis, but Eighty-five percent of these patients die before leaving range widely, with an average around 20 minutes (Dahal et al., the emergency department (Tien et al., 2007). Improved 2017). This data is not trauma specific, but could be used as a hemorrhage control has been shown to significantly guide for trauma patients. However, it is worthwhile to note improve patient outcomes (Kragh, 2009), and as a result, angiography patients are less likely to have trauma-induced controlling massive exsanguination should occur even coagulopathies, and will have a smaller single arterial puncture at a known location. before airway control (Forrest, Lax & van der Velde, 2014). Nurses play a major role in identifying and man- Dressings aging life-threatening hemorrhage; the skills required Direct pressure is usually applied using a dressing. Dressings can to initially control hemorrhage are nursing skills. This be manufactured, or improvised, but ideally, they will be: ster- paper will discuss foundational knowledge for basic ile, absorbent, non-stick, and lint-free. Although there are many hemorrhage control interventions, describe how to use different dressings on the market for hemorrhage control, hemo- basic manoeuvres, and how to escalate hemorrhage static or non-hemostatic dressings are usually used.
    [Show full text]