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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