The military anti-shock trouser in civilian pre-hospital emergency care.
01 Oct 1973-Journal of Trauma-injury Infection and Critical Care (J Trauma)-Vol. 13, Iss: 10, pp 843-848
About: This article is published in Journal of Trauma-injury Infection and Critical Care.The article was published on 1973-10-01. It has received 102 citations till now. The article focuses on the topics: Shock (circulatory).
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TL;DR: A basic management protocol is proposed that organizes combat casualty care into three phases and suggests appropriate measures for each phase and several sample scenarios are presented and discussed.
Abstract: Background: Prior to the onset of hostilities in Afghanistan, there had been very few significant advances in battlefield trauma care for the last 125 years. In 1996, the original Tactical Combat Casualty Care (TCCC) Guidelines were published in Military Medicine. TCCC is a set of evidence-based, best-practice prehospital trauma care guidelines customized for use on the battlefield.Methods: The conflicts in Iraq and Afghanistan have been the longest continuous period of armed conflit in our nation’s history. During that time, TCCC has steadily evolved as additional prehospital trauma care evidence became available and as feedback from user medics, corpsmen, and pararescuemen was gained.Findings: TCCC has been in the forefront of advocating for battlefield trauma care advances, to include the aggressive use of tourniquets and hemostatic dressings for the control of life-threatening external hemorrhage; improved fluid resuscitation techniques for casualties who are in hemorrhagic shock; a focus on airway positioning and surgical airways to manage casualties with airway trauma; safer and more effective battlefield analgesia; the use of intraosseous vascular access when peripheral IVs are difficult to start; battlefield antibiotics; and combining good medicine with good small-unit tactics.Discussion: TCCC at the point in time has been well-documented to produce unprecedented decreases in preventable combat fatalities in military units that have trained all of their unit members – not just medics - in TCCC. This proven success has made TCCC the standard for battlefield trauma care in the US military and for the militaries of many of our allied nations. The Committee on TCCC and the Joint Trauma System work in close concert with civilian trauma colleagues through such initiatives as the Hartford Consensus, the White House Stop the Bleed campaign, and the development of National Association of Emergency Medical Technicians. These strategic partnerships have enabled TCCC advances in prehospital trauma care to be translated into civilian trauma care practice. Active shooter events, terrorist bombings, and the everyday trauma that results from motor vehicle crashes, household accidents, and criminal violence create the potential for many lives to be saved in the civilian sector as well. The Department of Defense’s Joint Trauma System, including the Committee on TCCC, has been recognized as a national resource and designated by Congress as the lead agency for trauma in the US Military.
340 citations
TL;DR: The aggregated data in the literature have failed to demonstrate a benefit for on-site ALS provided to trauma patients and support the scoop and run approach.
Abstract: Background: The question of whether to use advanced life support (ALS) or basic life support (BLS) for trauma patients in the prehospital setting has been much debated and still lacks a clear answer. The purpose of this study was to conduct a comprehensive critical review of the literature regarding this controversy Methods: A total of 174 articles on prehospital ALS or BLS for trauma were reviewed. Fifteen of these studies were found to involve mortality statistics for both ALS- and BLS-treated patients. Odds ratios were calculated for survival in ALS versus BLS and summarized across studies on the basis of multivariate scoring systems that incorporated both design and methodological assessment. Overall odds ratios for all studies were calculated on the basis of both raw data from the papers, and weighted odds ratios were calculated from the scoring systems. Results: Six studies were scored as being methodologically average (5 favoring BLS and 1 favoring ALS), two were scored as good (1 favoring BLS and 1 favoring ALS), seven as excellent (6 favoring BLS and 1 favoring ALS). Ten studies had an average study design score (6 favoring BLS and 4 favoring ALS) and seven had a good study design score (6 favoring BLS and 1 favoring ALS). Weighted odds ratio for dying was 2.59 for patients receiving ALS compared with those receiving BLS. The crude odds ratio was 2.92. Conclusion: The aggregated data in the literature have failed to demonstrate a benefit for on-site ALS provided to trauma patients and support the scoop and run approach.
259 citations
TL;DR: ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest and may have produced a return of spontaneous circulation in three patients refractory to standard measures.
Abstract: Objective. —To describe and compare with standard cardiopulmonary resuscitation (CPR) in humans a new form of CPR that involves both active compression and active decompression of the chest. Design. —Patients in cardiac arrest in whom standard advanced cardiac life support failed were randomized to receive 2 minutes of either standard or active compression-decompression (ACD) CPR using a custom, hand-held suction device, followed by 2 minutes of the alternate technique. The ACD device was applied midsternum and used to perform CPR according to the guidelines of the American Heart Association: 80 compressions per minute, compression depth of 3.8 to 5 cm, 50% duty cycle, and constant-volume ventilation. Mechanical Thumper CPR was also compared in five patients. End-tidal carbon dioxide (ETco2) concentrations and hemodynamic variables were measured. Transesophageal Doppler echocardiography was used to assess contractility, the velocity time integral (an analogue of cardiac output), and diastolic myocardial filling times. Results. —Ten patients were enrolled. The mean±SD ETco2 was 4.3±3.8 mm Hg with standard CPR and 9.0±3.9 mm Hg with ACD CPR (P Conclusion. —ACD CPR is a simple manual technique that improved cardiopulmonary circulation in 10 patients during cardiac arrest. Although ACD CPR may have produced a return of spontaneous circulation in three patients refractory to standard measures, its impact on survival when used early in cardiac arrest remains to be determined. (JAMA. 1992;267:2916-2923)
252 citations
TL;DR: It is concluded that active compression-decompression CPR is a simple technique that appears to improve coronary perfusion pressure, systolic arterial pressure, cardiac output, and minute ventilation in nonventilated animals when compared with standard CPR.
127 citations
TL;DR: The Percluder was more effective than the MAST plus volume replacement in controlling hemorrhage and prolonging four-hour survival from blunt splenic trauma in an animal model.
85 citations