ABSTRACT

This case study evaluates a simple, reliable technique for preserving a unit of blood in the field. During a search and rescue exercise in mountainous terrain, a unit of blood was drawn and stored in the rescuer’s chest pocket for 13 hours while engaging in rigorous training. Despite temperatures as low as 4°C (40°F), the blood remained liquid and appeared visually viable, suggesting that body heat may help maintain adequate storage temperature. This method offers a low-resource alter-native to expensive or logistically complex storage solutions. A review of historical and modern literature supports the potential effectiveness of this approach, though the absence of laboratory analysis limits definitive conclusions. Given its practicality and historical precedent, this approach warrants further research on biochemical integrity and long-term feasibility to assess its viability for emergency transfusions in combat and wilderness rescue settings.

Keywords: blood; whole blood; blood storage; austere medicine; wilderness medicine; tactical medicine

Vascular Ultrasonography Performed by Special Operations Forces Combat Medics: A Feasibility Study

Turner BL, van de Voort JC, van der Burg BL, Fransen CM, van Ooij PA, Hoencamp R 25(3). 95

Abstract:

Introduction: Two-dimensional venous ultrasound may be a viable substitute for standard Doppler ultrasonography in monitoring and evaluating decompression stress. Preliminary data possibly show that ultrasound recordings of the inferior vena cava (IVC) and popliteal vein (PV) can indicate elevated decompression stress. This study aims to evaluate the feasi-bility of a microteaching program for training combat med-ics to conduct ultrasound measurements on the IVC and PV for self-monitoring of decompression stress on the waterside. Methods: A vascular surgeon provided a microteaching course to combat medics of the Netherlands Armed Forces. Two Lumify® (Philips Medical Systems International B.V., Best, The Netherlands) handheld ultrasound devices were used, connected to a Samsung Galaxy Tab A® (generation 10.5, Samsung, Suwon, South-Korea) or a Panasonic FZ-A2® tablet (Panasonic, Kadoma, Japan). The IVC was examined using the C5-2 abdominal probe, and the PV was assessed using the L12-4 linear probe. Combat medics performed and recorded measurements observed by a vascular surgeon on their randomly assigned partners after 2 minutes of practice. Three outcomes were measured in this study: (1) observer assessment of the performance, (2) self-perceived procedure experience, and (3) video recording quality scored by a vascular surgeon and researcher. Results: A total of 25 Special Operations Forces combat medics took part in this study. All but one participant recorded the correct vessels. Recordings of the IVC and PV were achieved in a mean time of 50 (SD 26) seconds and 1 minute and 26 seconds (SD 55s), respectively. The participants didn’t report a difference in difficulty of obtaining a clear image of either vessel. Both assessors assigned median and modal scores of at least 4 out of 5 for all image quality categories. Conclusion: This microteaching program is an effective training technique for military medical personnel with little to no ultrasound experience to obtain ultrasound images of the IVC and PV. Our findings suggest that combat medics could perform vascular ultrasound measurements, which could be used to screen for high decompression stress in the future.

Keywords:  ultrasound; Special Operations; decompression stress; diving; microteaching

ABSTRACT

Introduction: The Department of Defense has continually refined body armor to mitigate battlefield injuries over the last 20 years. Penetrating axilla injuries remain challenging despite adoption of a four-plate ceramic armor system. This study investigates the efficacy of current armor configurations in reducing mortality and morbidity associated with axilla injuries. Methods: This was a retrospective case series using afteraction reports from a single Special Operations unit. Records (786) from 2001-2018 were screened, yielding 11 meeting inclusion criteria. Data included injuries, body armor type, clinical interventions, and outcomes. Results: Analysis revealed significant mortality (45%) among casualties sustaining axilla injuries, with 100% mortality for those struck in uncovered side-plate regions under a two-plate system. In contrast, no fatalities occurred when injuries were within protected side-plate regions of a four-plate system. Injury patterns showed consistent thoracic cavity violations, emphasizing the need for robust protection strategies. This study underscores the efficacy of four-plate systems in reducing mortality compared to older configurations, particularly in protecting vital structures like great vessels and the heart. However, limitations in current side-plate coverage suggest potential gaps in protection, especially superiorly. Balancing protection with mobility remains crucial, as highlighted by operational challenges and weight concerns. Conclusion: Findings support the role of side plates in mitigating axilla injuries but highlight the need for expanded coverage using improved material technologies. Fu-ture research should focus on enhancing ballistic protection without compromising operational agility and refining trauma management protocols for optimal casualty outcomes.

Keywords: axilla; exsanguination; gunshot wound; mediastinal injury; transmediastinal gunshot wound; ballistic plates; body armor; combat injury; military trauma

Current Episode is Fall 2025

Our JSOM podcast team will be reviewing the following articles for our newest podcast: 

Penetrating Axilla Injuries in Ceramic Plate Coverage: Matthew unpacks a compelling case series on the effectiveness of four-plate body armor systems in protecting vital axillary structures, drawing from his own experience as a Ranger medic.

https://jsomonline.org/product/penetrating-axilla-injuries-and-ceramic-plate-coverage-a-special-operations-case-series/

Mitigating Heat Loss in IV Tubing During Austere Blood Transfusions: Sydney reviews a West Point study quantifying how cold environments impact transfusion safety—and what innovations might help preserve blood temperature in the field.

https://jsomonline.org/product/mitigating-heat-loss-in-iv-tubing-during-austere-blood-transfusions/

Lab Evaluation of Four Ukrainian-Manufactured Tourniquets: Jessica breaks down a comparative study assessing the performance, durability, and design of Ukrainian tourniquets under simulated battlefield conditions.

https://jsomonline.org/product/lab-evaluation-of-four-ukrainian-manufactured-tourniquets/

Plus, Dr. Dan Godbee highlights two additional must-read articles on prehospital blood use and JSOM’s ongoing commitment to mentoring medics through the publishing process.



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