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Michelle DuGuay Landers, MBA, BSN, RN

Breakaway Media, LLC

Publisher

Journal of Special Operations Medicine (JSOM)

Lt Col, USAF/NC (Ret)

[email protected]

www.JSOMonline.org

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ABSTRACT

We sought to better understand the frostbite risk during first-aid tourniquet use by reviewing information relevant to an association between tourniquet use and frostbite. However, there is little information concerning this subject, which may be of increasing importance because future conflicts against near-peer competitors may involve extreme cold weather environments. Historically, clinical frostbite cases with tourniquet use occurred in low frequency but in high severity when leading to limb amputation. The physiologic response of vasoconstriction to cold exposure leads to limb cooling and causes a reduction of limb blood flow, but cold-induced vasodilation ensues as periodic fluctuations that increase blood flow to hands and feet. In animal experiments, tourniquet use increased the development of frostbite. Evidence from human experiments also supports an association between tourniquet use and frostbite. Clinical guidance for caregiving to casualties at risk for frostbite with tourniquet use had previously been provided but slowly and progressively dropped out of documents. Conclusions: The cause of frostbite was deduced to be a sufficiently negative heat-transfer trend in local tissues, which tourniquet use may worsen because of decreasing tissue perfusion. An association between tourniquet use and frostbite exists but not as cause and effect. Tourniquet use increased the risk of the cold causing frostbite by allowing faster cooling of a limb because of reduced blood flow and lack of cold-induced vasodilation. Care providers above the level of the lay public are warned that first-aid tourniquet use in low-temperature (<0°C [<32°F]) environmental conditions risks frostbite.

ABSTRACT

Background: Research among military personnel and veterans indicates that subjective appraisal of warzone stressors explains the relation of combat exposure to posttraumatic stress disorder (PTSD), but not the relation of exposure to injury and death to PTSD. Studies have primarily been limited to conventional forces using aggregate measures of warzone stressor exposure. Threat appraisal may play a different role in the emergence of PTSD among military personnel for whom dangerous deployment experiences are more closely associated with exposure to injury and death, such as US Air Force Pararescuemen and Combat Rescue officers. Materials and Methods: In a sample of 207 rescue personnel, correlations among various types of warzone stressor exposure, threat appraisal, and postdeployment PTSD symptoms were examined. Results: The relative strongest correlates of threat appraisal were stressors related to injury, death, and human remains. Although exposure to these stressors was also correlated with PTSD symptom severity, partial correlations of stressor exposure and PTSD symptoms were no longer significant when adjusting for threat appraisal. Conclusion: Results support the contributing role of threat appraisal to PTSD among military personnel whose primary duties entail exposure to injury and death under hostile and dangerous conditions.



ABSTRACT

Background: Exsanguination is the leading cause of preventable posttraumatic death, especially in the prehospital arena. Traditional hemorrhage control methods involve packing the wound with hemostatic agents, providing manual pressure, and then applying a pressure dressing to stabilize the treatment. This is a lengthy process that frequently destabilizes upon patient transport. Conversely, the iTClamp, a compact wound closure device, is designed to rapidly seal wound edges mechanically, expediting clot formation at the site of injury. Objectives: To determine the efficacy of the iTClamp with and without wound packing in the control of a lethal junction hemorrhage. Methods: Given the limited available information regarding the efficacy of the iTClamp in conjunction with traditional hemostatic agents, this study used a swine model of severe junctional hemorrhage. The goal was to compare a multiagent strategy using the iTClamp in conjunction with XSTAT to the traditional method of Combat Gauze packing with pressure dressing application. Readouts include application time, blood loss, and rebleed occurrence. Results: Mean application times of the iTClamp treatment alone or in conjunction with other hemostatic agents were at least 75% faster than the application time of Combat Gauze with pressure dressing. Percent blood loss was not significantly different between groups but trended the highest for Combat Gauze treated swine, followed by iTClamp plus XSTAT, iTClamp alone and finally iTClamp plus Combat Gauze. Conclusion: The results from this study demonstrate that the iTClamp can be effectively utilized in conjunction with hemostatic packing to control junctional hemorrhages.

Keywords: iTClamp; hemorrhage; trauma; junctional wounds; hemostatic agent

The JSOM podcast digs deeper into the articles and subjects that matter to our readers. Our podcast hosts, Captains Alex Merkle and Josh Randles, tackle articles from the journal based on merit, interest, and application for operators in the field.

Current Episode

The new Winter 2022 episode of the JSOM podcast is now available on our website and wherever you listen to podcasts.

Our guest medic editor this quarter is Devin DeFeo, a former SOF medic. 2LT DeFeo enlisted in the Army in 2004 and served as an 18D with 1SFG(A) and USASOC. As a medic, he authored the concept for MARCHE2 for TCCC in the chemical, biological, radiological, and nuclear (CBRN) environment published in JSOM, which later formed the framework for the Joint Trauma System Clinical Practice Guidelines on CBRN medicine and the CBRN chapter in the Ranger Medical Handbook. He then participated in the Enlisted to Medical Degree Preparatory Program (EMDP2) at George Mason University, earning a master of science in biology. He is currently a third-year medical student at the Uniformed Services University of the Health Sciences (USUHS). 2LT DeFeo is considering a residency in emergency medicine. He will be reviewing Does Mental and Visual Skills Training Improve High-Value Target Identification and Marksmanship Among Elite Soldiers? by J. Jay Dawes, et al. (p. 22). Our author interview is with Michael J. Egnoto, PhD (An Exploratory Comparison of Water-Tamped and -Untamped Explosive Breaches: Practical Applications for the Tactical Community via Pilot Study). Dr Egnoto is affiliated with the Walter Reed Army Institute of Research, Forest Glen Annex, Silver Spring, MD.

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If your institution is not on the list and you want more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.

For over 20 years, the Journal of Special Operations Medicine (JSOM) has brought important, lifesaving information to the Special Operations Forces (SOF) community. And over the years, as our audience and readership has expanded into over 80 countries, physicians, military and tactical medics, and other medical professionals working in unconventional environments rely on the JSOM for breakthrough research at the intersection of operational medicine and tactical casualty care. Our peer-reviewed research and interactive clinical content make the JSOM a must-read for:

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For these reasons, many of the world’s top medical technology companies and medical device distributors make the JSOM a cornerstone of their advertising programs. And with a strong multichannel and social media presence, the JSOM offers the most dynamic print and digital media options at cost-effective prices. For medical marketers worldwide looking to reach our niche audience, the JSOM is the gold standard. For more information, please see our attached media kit.

PORTSMOUTH, VA, UNITED STATES

U.S. Navy Photo by Mass Communication Specialist 1st Class Donald R. White Jr.

Naval Medical Center - Portsmouth

DVIDS

Cmdr. Ryan Gnandt, from Rootstown, Ohio, simulates cutting open an airway for a patient during tactical combat casualty care (TCCC) training at Naval Medical Center Portsmouth, March 10, 2023. TCCC aims to reduce combat deaths while allowing a unit to complete its mission and provide the best possible care for casualties on the battlefield.

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