Podcast Episode 46: Bleeding in the Box: Non-Compressible Torso Hemorrhage with Dr. Mark Shapiro
Many efforts in the pre-hospital combat environment had been aimed at prolonging the viability of a patient until they are able to make it to a surgeon. The goal of military triage and evacuation is to have urgent surgical patients to a waiting surgical team within 2 hours. Despite our best efforts, this is not always possible. When it is not, it is important to do the simple interventions which we know make a difference for combat casualties such as tourniquets, wound packing, needle decompression and airway adjuncts. Wounds causing non-compressible hemorrhage to the torso need additional strategies to bridge the time and space gap to definitive treatment. A non-surgical adjunct which has shown the most promise to this point has been the early transfusion of whole blood and blood products. Our newest Clinical Practice Guideline on Remote Damage Control Resuscitation details what should be done and why.
There is an entirely separate working group, The Tactical Hemostasis, Oxygenation and Resuscitation (THOR) group dedicated to exactly those principles. Despite all that effort and brain power however, blood remains a finite resource in the austere environment and Medics have faced terrible situations where even blood administration is not enough and surgery is too far away. It is in these times of worst-case desperation that we want to do more for our patients. Some of the adjuncts discussed in this episode are abdominal tourniquets, REBOA and open surgical procedures. We don’t take any of this lightly and realize that for the vast majority of our pre-hospital audience, many of the procedures discussed are far outside the current scope of practice.
What is possible?
What is responsible?
What is sustainable?
Enjoy the talk.
Episode 41: The Death of the Golden Hour: SOMSA 2018 Talk, by COL (Ret.) Rocky Farr, MD
Colonel Warner “Rocky” Farr has made an important contribution to the body of SOF knowledge with this well-researched monograph. He advances the understanding of the many challenges and accomplishments related to guerrilla warfare medicine
Podcast Episode 36: ROLO to SOLO: The Logistics of Fresh Whole Blood Transfusion
A Special Operations Battalion Surgeon explains how to easily navigate the logistics of setting up a battalion wide blood transfusion program.
Podcast Episode 29: Dr. Cap on Fresh Whole Blood and Resuscitation for PFC
Dr. Cap has been leading the way here in the US with the Armed Services Blood Program on fresh whole blood transfusion research in conjunction with the THOR Network and answering
Podcast 22: On Blood, Geir Strandenes at SOMSA 2017
Are you familiar with the concept of oxygen debt or oxygen deficit? What constitutes a “dose” of shock? What systolic BP constitutes hypotension on the battlefield? Where did the concept of permissive hypotension come from? Is it still valid? How long can fresh whole blood last? Blood Transfusions were a huge topic at this year’s meeting in Charlotte with no less than 3 major speakers giving multiple talks on the subject. This talk was recorded during the Prolonged Field Care Pre-Conference Lab during the Special Operations Medicine and Scientific Assembly(SOMSA) by Dr. Geir Strandenes.
THOR Fresh Whole Blood Triage and Screening Tool
The Trauma Hemostasis and Oxygenation Research (THOR) Group