THE JOURNAL FOR OPERATIONAL MEDICINE AND TACTICAL COMBAT CASUALTY CARE
For 20 years, the Journal of Special Operations Medicine (JSOM) has been the only published venue that brings together military SOF, civilian Tactical EMS, and federal Department of Justice agencies with tactical medical assets. Originally established by the Command Surgeon's Office of the United States Special Operations Command (USSOCOM-SG), we have grown into one of the world's most renowned peer-reviewed medical journals, now subscribed to in 80 countries!
Journal of Special Operations Medicine (JSOM) Newsletter
15 September 2020 - Issue 181
ABSTRACT

First introduced in 1996, Tactical Combat Casualty Care (TCCC) redefined prehospital, point-of-injury (POI), battlefield trauma care for the human combat casualty. Today, many consider TCCC as one of the most influential interventions for reducing combat-related case fatality rates from preventable deaths in human combat casualties. Throughout history, Military Working Dogs (MWDs) have proved and continue to prove themselves as force multipliers in the success of many military operations. Since the start of the Global War on Terror in 2001, these elite canine operators have experienced an upsurge in combat-related deployments, placing them at a higher risk for combat-related injuries. Until recently, consensus- based Canine-TCCC (K9TCCC) guidelines for POI battlefield trauma care did not exist for the MWD, leaving a critical knowledge gap significantly jeopardizing MWD survival. In 2019, the Canine Combat Casualty Care Committee was formed as an affiliate of the Committee on Tactical Combat Casualty Care with the intent of developing evidence- based, best practice K9TCCC guidelines. Modeled after the same principles of the human TCCC, K9TCCC focuses on simple, evidence-based, field-proven medical interventions to eliminate preventable deaths and to improve MWD survival. Customized for the battlefield, K9TCCC uniquely adapts the techniques of TCCC to compensate for canine-specific anatomic and physiological differences.

September 2020 JSOM Feature Article
Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even "Knee BOA"
O'Dochartaigh D, Picard CT, Brindley PG, Douma MJ. 20(2). 110 - 114. (Journal Article)

ABSTRACT

Introduction: Abdominal-pelvic hemorrhage (i.e., originates below the diaphragm and above the inguinal ligaments) is a major cause of death. It has diverse etiology but is typically associated with gunshot or stab wounds, high force or velocity blunt trauma, aortic rupture, and peripartum bleeds. Because there are few immediately deployable, temporizing measures, and the standard approaches such as direct pressure, hemostatics, and tourniquets are less reliable than they are with compressible extremity injuries, risk for death resulting from abdominal-pelvic hemorrhage is high. This review concerns the exciting potential of proximal external aortic compression (PEAC) as a temporizing technique for life-threatening lower abdominal-pelvic hemorrhage. PEAC can be accomplished by means of a device, two locked arms (manual), or a single knee (genicular) to press over the midline supra-umbilical abdomen. The goal is to compress the descending aorta and slow or halt downstream hemorrhage while not delaying more definitive measures such as hemostatic packing, tourniquets, endovascular balloons, and ultimately operative repair. Methods: Clinical review of the Ovid MEDLINE, In-Process, & Other Non-Indexed, and Google Scholar databases was performed for the period ranging from 1946 to 3 May 2019 for studies that included the following search terms: [proximal] external aortic compression OR vena cava compression AND (abdomen or pelvis) OR (hemorrhage) OR (emergency or trauma). In addition, references from included studies were assessed. Conclusion: Sixteen studies met the inclusion criteria. Evidence was grouped and summarized from the specialties of trauma, aortic surgery, and obstetrics to help prehospital responders and guide much-needed additional research, with the goal of decreasing the high risk for death after life-threatening abdominal-pelvic hemorrhage.

Keywords: hemorrhage; trauma; shock; junctional trauma; noncompressible hemorrhage; prehospital care; austere environment; proximal external aortic compression; PEAC
The Journal Of Special Operations Medicine Podcast
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. In addition, the podcast features a special, not to be missed Interview Series with leaders, doctors, and authors.
Podcast News And Updates
Our October 1st eNewsletter will be updated with information regarding brand new interviews and conversations coinciding with the release of the Fall 2020 edition of the Journal of Special Operations Medicine. For now, please be sure to review and catch up on all the highlights from Summer.

In the Summer 2020 episode of the JSOM Podcast, Alex and Josh discuss the article, "Step Duration Effects on Blood Loss in Simulated Designs of Tourniquet Use Procedure". Guest Will Price breaks down the article, "Clothing Effects on Limb Tourniquet Application", and authors Matt Douma and Peter Brindley discuss their article, "Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even 'Knee BOA'.

  1. Step Duration Effects on Blood Loss in Simulated Designs of Tourniquet Use Procedure Kragh JF, Aden JK, Dubick MA.
  2. Guest Will Price discusses: Clothing Effects on Limb Tourniquet Application. Wall PL, Buising CM, Hingtgen E, Smith H, Renner CH. Drs. Matt Dumas and Peter Brindley discuss their paper:
  3. Temporizing Life-Threatening Abdominal-Pelvic Hemorrhage Using Proprietary Devices, Manual Pressure, or a Single Knee: An Integrative Review of Proximal External Aortic Compression and Even "Knee BOA" O'Dochartaigh D, Picard CT, Brindley PG, Douma MJ.

Duration: 37:10
Highlights From The 20th Anniverseary JSOM Interview Series:
MAJ Andrew Fisher, MS-4, PA-C, LP for a great review of pre-hospital whole blood in the military; where we are now and how we got there. He reminds us that, "everything old is new again." The first whole blood transfusion research was done by the military in 1940 (Armed Forces Blood Program) and was used extensively in WWII and the Korean War. But times change and lessons learned are lost to the sands of time as one generation of peacetime military surgeons hands off the reigns to the next. Listen here.

World-renowned tourniquet expert Dr. John Kragh. In this interview, Dr. Kragh takes us through his history in becoming a tourniquet expert as well as detailing the evolution of tourniquet use in combat situations as a battalion surgeon in Southwest Asia. Tourniquet use has evolved considerably even during the 20-years since the JSOM has been in publication. Be sure to read Dr. Kragh's contributions to this quarter's journal as a companion to this interview. Listen here.

CMSgt Michael Rubio, currently the commandant of the 351st Special Warfare Training Squadron of the PJ schoolhouse at Kirkland AFB. It's a great opportunity to hear from the best about how PJ training has changed during the past 20 years, and get a glimpse of where it is heading in the future. You can listen here. Look for another episode later this month.
JSOM Podcast
EMS Shared Science And Media Exchange
In an effort to broaden and strengthen our ties with the civilian emergency medical services community, we have recently decided to partner with the EMS World podcast from EMSWorld (EMS - EMT - Paramedic - Emergency Medical Services) in a shared science and media exchange program. The Journal of Special Operations Medicine has become an increasingly relevant source of information for Tactical and Emergency Medical Services personnel. Our statistics show that a large number of people who identify as EMS professionals are actively following us on social media. In addition to our own podcast episodes, we will now be streaming the occasional bonus episode from the EMS World podcast archive on our platforms. Our first selection is an episode we know will be of interest to our audience: From the Streets to the Battlefield: EMS Meets Combat Medicine. Stream episodes from the EMS World archive right on the JSOM podcast page.

Management of COVID-19 in Austere Operational Environments (Prehospital & Prolonged Field Care)

This practice management guide does not supersede DoD Policy. It is a guideline only and not a substitute for clinical judgment. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The practice management guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. 

World Trauma Symposium and EMS World Expo

Register today for the World Trauma Symposium, bringing cutting-edge trauma education from internationally renowned experts who will discuss Trauma Care in a Changing World. 

The program includes:

·Captain Brendan Drew, MD - latest on TBI and tranexamic acid;
·COL Jennifer Gurney, MD - the military's latest advances and research in prehospital trauma care;
·Bellal Joseph, MD - Zone I REBOA vs AAJT vs manual external aortic compression in the prehospital environment;
·Sheldon Teperman, MD - managing trauma during civil unrest and a pandemic;
·Meg Morgan, MD - prehospital analgesia - Ketamine vs OTFC vs Morphine vs Dsuvia; and
·Matt Harman, EMT-P, CCEMT, FP, SMS - suspected tension pneumothorax: needle decompression vs finger thoracostomy.

The World Trauma Symposium will be held virtually in conjunction with EMS World Expo, September 14 and 15. Choose one full program or two half-day beginning at just a $50 registration fee. Attendees can receive up to 8 hours of ACCME or CAPCE-approved credits
Institutional Subscribers And Re-subscribers
The JSOM is incredibly grateful to have the support of many institutions around the world. We would like to thank our recent institutional subscribers and re-subscribers for their support by acknowledging them in our eNewsletter and, when applicable, sharing their social media information. We reached a milestone, surpassing 50 institutions! We currently have 55 active institutional subscriptions, reaching a potential 59,000+ readers!

In this edition, we welcome back 1 returning institution

Korps Commando Troepen - Roosendaal, The Netherlands

Visit https://jsom.us/Library for a full list of institutions that are currently subscribing to the JSOM. We are beginning a campaign to expand our institutional subscriptions. If you think your company would benefit from an institutional subscription, let us know! We'll be happy to talk to you and get the ball rolling. You don't have to be a university or medical center to subscribe - we have many EMS units, government agencies, and military medical units both in the United States and abroad.

Are you on the list? Great! Need to know how to access our resources? You can either contact your head librarian, or shoot an email to subscriptions@JSOMonline.org.

Institutions receive either a print copy of our journal, digital access, or both. Digital subscribers have unlimited access to our full compendium of articles, journals, and the ATP-P. If you are a student, researcher, doctor, or other medical professional at one of these institutions, please contact your librarian for login details. Additionally, the digital resources are typically available 2-3 weeks ahead of print publication.

If your institution is not on the list and you would like more information about our institutional access, contact our subscriptions manager, Dr. Scott Graverson.
Photo of the Week
Air Force Special Tactics operators conduct a static line jump out of a C-130H Hercules, assigned to the 908th Airlift Wing from Maxwell Air Force Base, Georgia, following a Rigged Alternate Method Boat package into the water during training at Eglin Range, Florida. The training was conducted to ensure operators are familiar with static line jump procedures and working with a RAMB package for water rescues. (U.S. Air Force photo by Tech. Sgt. Rose Gudex)

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