Remote Damage Control Resuscitation A Military Perspective
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1 Remote Damage Control Resuscitation A Military Perspective Joseph F. Rappold, MD FACS CAPT MC USN (Ret) Department of Surgery Temple University School of Medicine
2 We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would do us harm. George Orwell
3 Casualty Epidemiology
4 Fundamental Approach Most all would agree that the tenants of TCCC should be adhered to Minimal time doing anything other than life-saving interventions scoop and run (USA Dust-off/USAF Pedro) vice scoop, run and play (UK MERT) Truly need to be thinking in terms of time to definitive surgical intervention
5 Key Concepts Hypotensive resuscitation per TCCC guidelines Radial pulse and normal mentation = no IV access; no fluids en-route Absence of above casualty receives 500cc Hextend; maybe repeated in 30 min if no improvement for a total of 1L Hextend TXA for those anticipated needing MT Identify the critically injured early not always that easy
6
7
8 Evacuation time 15
9 Evacuation time 15
10 Evacuation time 15
11 Evacuation time 15
12 Evacuation time 15 Colloid Plasma, Gelatins
13 Evacuation time 15 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available
14 Evacuation time 15 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA
15 Evacuation time 15 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia
16 Evacuation time 15 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia Pain control and Antibiotics
17 Evacuation time 45
18 Evacuation time 45
19 Evacuation time 45
20 Evacuation time 45
21 Evacuation time 45 Colloid Plasma, Gelatins
22 Evacuation time 45 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available
23 Evacuation time 45 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA
24 Evacuation time 45 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia
25 Evacuation time 45 Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia Pain control and Antibiotics
26 Evacuation time 2hrs
27 Evacuation time 2hrs
28 Evacuation time 2hrs
29 Evacuation time 2hrs
30 Evacuation time 2hrs Colloid Plasma, Gelatins
31 Evacuation time 2hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available
32 Evacuation time 2hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA
33 Evacuation time 2hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia
34 Evacuation time 2hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia Pain control and Antibiotics
35 Evacuation time 6hrs
36 Evacuation time 6hrs
37 Evacuation time 6hrs
38 Evacuation time 6hrs
39 Evacuation time 6hrs Colloid Plasma, Gelatins
40 Evacuation time 6hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available
41 Evacuation time 6hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA
42 Evacuation time 6hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia
43 Evacuation time 6hrs Colloid Plasma, Gelatins Blood/Blood products prbcs, FFP, FWB if readily available TXA rfviia Pain control and Antibiotics
44 Final Thoughts Need to have situational awareness regarding time to definitive surgical intervention Blood and blood product usage is important in the critically wounded/ injured Need to provide clear and concise guidance to medics/corpsmen
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