ABSTRACT



Background: Military helicopter mishaps frequently lead to multiple casualty events with complex injury patterns. Data specific to this mechanism of injury in the deployed setting are limited. We describe injury patterns associated with helicopter crashes. Materials and Methods: This is a secondary analysis of a Department of Defense Trauma Registry (DODTR) dataset from 2007 to 2020 seeking to describe prehospital care within all theaters in the registry. We searched within the dataset for casualties injured by helicopter crash. A serious injury was defined by an abbreviated injury scale of =3 by body region. Results: We identified 120 casualties injured by helicopter crash within the dataset. Most were Army (64%), the median age was 30 (interquartile range [IQR] 26-35), and most were male (98%), enlisted service members made up the largest cohort (47%), with most injuries occurring during Operation Enduring Freedom (69%). Only 2 were classified as battle injuries. The median injury severity score was 9 (IQR 4-22). Serious injuries by body region are the following: thorax (27%), head/neck (17%), extremities (17%), abdomen (11%), facial (3%), and skin/superficial (1%). The most common prehospital interventions focused on hypothermia prevention/management (62%) and cervical spine stabilization (32%). Most patients survived to hospital discharge (98%). Conclusions: Serious injuries to the thorax were most common. Survival was high, although better data capture systems are needed to study deaths that occur prehospital that do not reach military treatment facilities with surgical care to optimize planning and outcomes. The high proportion of nonbattle injuries highlights the risks associated with helicopters in general.

ABSTRACT

In parachuting, orthopedic and head injuries are well-documented risks associated with the parachute deployment and landing phases. Thoracic injuries have only been seen on rare occasion in conjunction with direct impact trauma. In this report, we detail a case of a young, healthy, tandem skydiving passenger who suffered bilateral pneumothoraces with delayed symptom onset, with no identifiable injury during the jump or landing. Exploring the forces of the parachute "opening shock," we suggest a plausible compressive mechanism for this novel presentation, as well as briefly discuss the options for diagnosis and conservative management of pneumothorax in the operational context. While this is an exceedingly rare event, pneumothorax should be considered in patients complaining of thoracic symptoms following a skydive.

ABSTRACT

Background: Transfusion of whole blood (WB) is a lifesaving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting WB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient WB at the point of injury to treat critically wounded patients or multiple hemorrhaging casualties. This study is a follow-up to the proof-of-concept study on the effect of airdrop on WB. In addition, this study confirms the statistical significance for the plausibility of using airdrop to deliver WB to combat medics treating casualties in the pre-hospital setting when Food and Drug Administration (FDA)-approved cold-stored blood products are not available. Methods: Forty-eight units of WB were collected and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a Standard Airdrop Training Bundle (SATB) parachute or 68-in pilot chute. Twenty-four of these units were dropped from a C-145 aircraft, and 24 were dropped from a

C-130 aircraft. A control group of 15 units of WB was stored in a blood cooler that was not dropped. Baseline and post-intervention laboratory tests were measured in both airdropped and control units, including complete blood count; prothrombin time/partial thromboplastin time (PT/PTT); pH, lactate, potassium, bilirubin, glucose, fibrinogen, and lactate dehydrogenase (LDH) levels; and peripheral blood smears. Results: The blood cooler, cooling packs, and all 48 WB units did not sustain any major damage from the airdrop. There was no evidence of hemolysis. Except for the one slightly damaged bag that was not sampled, all airdropped blood met parameters for transfusion per the Joint Trauma System Whole Blood Transfusion Clinical Practice Guideline and the Association for the Advancement of Blood and Biotherapies (AABB) Circular of Information for the Use of Human Blood and Blood Components. Conclusions: Airdrop of fresh or stored WB in a blood cooler with a chute is a viable way of delivering blood products to combat medics treating hemorrhaging patients in the pre-hospital setting. This study also demonstrated the portability of this technique for multiple aircraft. The techniques evaluated in this study have the potential for utilization in other austere settings such as wilderness medicine or humanitarian disasters where an acute need for WB delivery by airdrop is the only option.

Keywords: whole blood transfusion; airdrop; airdrop blood; aerial resupply; Tactical Combat Casualty Care

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 Summer 2022 podcast features articles written primarily by medics and non-physicians. This entire edition of the journal is focused on the Critical Care aspect of SOF Medicine, so we wanted to invite the tip of the spear medics to talk about their research on this episode. The first article is, "Analgesia and Sedation in the Prehospital Setting: A Critical Care Viewpoint" by Taylor DeRosiersm et. al. "Mechanical Ventilation: A Review for Special Operations Medical Personnel" by Jonathan Friedman and Seth Assar follows. We finish up with, "Airway Management With Noninvasive Positive Pressure Ventilation" by Papalski, Siedler, and Callaway.

The Journal of Special Operations Medicine is proud to have the support of many great sponsors and media partners. Our sponsors are leaders in the field of military medical technology. Please help support these companies by following the links below to learn more about their missions and the products they offer. This section also features peridoic promtional information for events and conferences, including the 2023 SOMA Scientific Assembly. 

The University of Pittsburgh’s Trauma and Transfusion Medicine Research Program, Center for Military Medicine Research, McGowan Institute for Regenerative Medicine, in partnership with Trauma Hemostasis and Oxygenation Research, are proud to announce the HEmostatic REsuscitation and Trauma Induced Coagulopathy (HERETIC) Symposium CMMR/TTMRC/THOR happening October 11 and 12, 2022 at the Wyndham Pittsburgh University Center, Pittsburgh, PA.

The Combat Medical Care Conference and the 1st Special Operation Forces Medical Headquarter / French Military Medical Service are partnering for an international medical conference in Paris. The Paris Special Operation Forces Combat Medical Care Conference will be an international symposium dedicated to physicians and paramedics involved in Special Forces Operational Medicine.

All personnel involved in special operations medical support are invited to join this great event: military physicians, anesthesiologists, emergency physicians, nurses, specialized nurses, paramedics, trauma surgeons, specialized surgeons. Due to confidential aspects this conference is only for military personal. Limited to approximately 250 people. For more information, click on the link below and visit the website.

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Photograph by Staff Sgt. Adrian Brakeley

DVIDS

Members with the 221st and 239th Combat Communications Squadrons practice Tactical Combat Casualty Care maneuvers during Exercise BUMBU 22 at Camp Shelby, Mississippi, June 9, 2022. BUMBU 22 is a training exercise involving five geographically-separated combat communications squadrons from across the 254th Combat Communications Group. 

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