ABSTRACT

Background: The development of acute traumatic coagulopathy is associated with increased mortality and morbidity in patients with battlefield traumatic injuries. Currently, the incidence of acute traumatic coagulopathy in the Role 1 setting is unclear. Methods: We queried the Prehospital Trauma Registry (PHTR) module of the Department of Defense Trauma Registry (DoDTR) for all encounters from inception through May 2019. The PHTR captures data on Role 1 prehospital care. Data from the PHTR was linked to the DoDTR to analyze laboratory data and patient outcomes using descriptive statistics. We defined coagulopathy as an international normalized ratio (INR) of ≥1.5 or platelet count ≤150×109/L. Results: A total of 595 patients met the inclusion criteria; 36% (212) met our definition for coagulopathy, with 31% (185) carrying low platelet numbers, 11% (68) showing an elevated INR, and 7% (41) with both. The baseline (no coagulopathy) cohort had a mean INR of 1.10 (95% CI 1.09-1.12) versus 1.38 (95% CI 1.33-1.43) in the coagulopathic cohort. The mean platelet count was 218 (95% CI 213-223) ×109/L in the baseline cohort versus 117 (95% CI 110-125) ×109/L in the coagulopathic cohort. Conclusions: Our findings indicate a high incidence of coagulopathy in trauma patients. Approximately one-third of wounded patients had laboratory evidence of coagulopathy upon presentation to a forward medical care facility. Advanced diagnostic facilities are therefore needed to facilitate early diagnosis of acute traumatic coagulopathy. Blood products with a long shelf life can aid in early correction.

Lumbar Paraspinal Compartment Syndrome in an Active-Duty Army Special Operations Aviation Soldier

Wagner C, Davis G, Donato M, Bedard P, Bridwell R. 24(2). 73 - 77. (Case Reports)

ABSTRACT

Lumbar paraspinal muscle compartment syndrome is an uncommon, rapidly progressive, and potentially devastating injury with fewer than 40 cases reported in the literature. It initially mimics nonemergent causes of low back pain, disproportionately affects young men, and is most often secondary to acute physical exertion. The disease process is commonly associated with rhabdomyolysis. Diagnostic tools include physical examination, measurement of lactate and creatine kinase levels, MRI, and direct compartment pressure measurement. While medical and nonoperative management strategies have been explored, the gold standard for treatment is emergent lumbar fasciotomy. Opioid and non-steroidal pain management, as well as physical therapy, are the mainstays of post-treatment recovery, with many surgical patients reporting complete symptom resolution at long-term follow-up. This article discusses the case of a 27-year-old, male, active-duty, Special Operations Aviation Soldier who presented to the emergency department and was found to have lumbar paraspinal muscle compartment syndrome.

ABSTRACT

Aggregate statistics can provide intra-conflict and inter-conflict mortality comparisons and trends within and between U.S. combat operations. However, capturing individual-level data to evaluate medical and non-medical factors that influence combat casualty mortality has historically proven difficult. The Department of Defense (DoD) Trauma Registry, developed as an integral component of the Joint Trauma System during recent conflicts in Afghanistan and Iraq, has amassed individual-level data that have afforded greater opportunity for a variety of analyses and comparisons. Although aggregate statistics are easily calculated and commonly used across the DoD, other issues that require consideration include the impact of individual medical interventions, non-medical factors, non-battle-injured casualties, and incomplete or missing medical data, especially for prehospital care and forward surgical team care. Needed are novel methods to address these issues in order to provide a clearer interpretation of aggregate statistics and to highlight solutions that will ultimately increase survival and eliminate preventable death on the battlefield. Although many U.S. military combat fatalities sustain injuries deemed non-survivable, survival among these casualties might be improved using primary and secondary prevention strategies that prevent injury or reduce injury severity. The current commentary proposes adjustments to traditional aggregate combat casualty care statistics by integrating statistics from the DoD Military Trauma Mortality Review process as conducted by the Joint Trauma System and Armed Forces Medical Examiner System.

Keywords: combat casualty care statics; injury survivability mortality; trauma; battle injury; disease, non-battle injury

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. The Spring 24 episode is here!

Current Episode

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

Development and Implementation of a Standard Operating Procedure for Military Working Dog Blood Collection, Storage, and Transport by Elizabeth L. Evernham, Benjamin T. Fedeles, and Kayla M. Knuf (https://www.jsomonline.org/FeatureArticle/2024128Evernham.pdf)

Derivation of a Procedural Performance Checklist for Bifemoral Veno-Venous Extracorporeal Membrane Oxygenation Cannula Placement in Operational Environments by Elizabeth Powell, Richard Betzold, et al. (https://www.jsomonline.org/FeatureArticle/2024132Powell.pdf)

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments by Zachery L. Brown, Joshua P. Cuestas, Kevin J. Matthews, Jonathan T. Shumaker, Durwood W. Moore, and Rebekah Cole (https://www.jsomonline.org/FeatureArticle/2024138Brown.pdf)

JSOM Guest Editor Captain Cam Strawn reviews Development and Implementation of a Standard Operating Procedure for Military Working Dog Blood Collection, Storage, and Transport. Capt Strawn serves as an Air Force Combat Rescue Officer and combat veteran who teaches leadership as an Assistant Professor of Aerospace Studies at Brigham Young University, where he is also completing a premedical post-baccalaureate program. He is a SOFtoSOM Scholar applying to medical school this year.

JSOM Guest Authors

Emergency Fresh Whole Blood Transfusion Training for Ukrainian Health Professionals in Austere Environments authors SFC Zachery Brown and HM1 Kevin John Matthews are

interviewed by our podcaster team about their article. SFC Zachery Brown enlisted in the Army on 15 September 2009. He has served with the 75th Ranger Regiment for the past 13 years: 7 years in the 1st Ranger Battalion and 6 years in the Regimental Reconnaissance Company (RRC). He served as a Ranger Squad Leader, Regimental Reconnaissance Team (RRT) Medical Sergeant, RRT Assistant Team Sergeant, and RRC Operations NCOIC and has nine combat deployments to Afghanistan, Iraq, and Syria, amounting to over 500 Special Operations Raids. In 2021, the Uniformed Services University of Health Services (USUHS) selected him for one of seven Army slots for the 24-month Cohort 9, Enlisted to Medical Degree Preparatory Program (EMDP2). This program prepares top-performing enlisted Servicemembers to apply to medical school. He is currently enrolled as a graduate student and aims to continue serving our nation and global community as a military physician and medical officer in the United States Army. SFC Brown earned a BS in Biology, Bio-Engineering Concentration, from the University of Arkansas in 2008, an MS in Strategic Leadership from the University of Charleston, and is currently working towards completing an MS in Biology at George Mason University.

Hospital Corpsman First Class, HM1 (FMF/ SW) Kevin John Matthews enlisted in the Navy in 2016. Operationally, HM1 Matthews served as the Senior Line Corpsman, Scout Sniper Platoon, Weapons Company, 1st Battalion, 4th Marines, deploying to Africa and the Middle East aboard the 15th Marine Expeditionary Unit (MEU) in 2021. Upon returning from deployment, the Navy Education and Training Office (NETO) selected HM1 Matthews as a Combat Trauma Management and Valkyrie Emergency Fresh Whole Blood Transfusion training instructor. He oversees the training of all medical personnel attached to Marine Corps expeditionary ground forces at 1st Marine Division, Camp Pendleton, CA. Hand-selected by the Division Surgeon, he was appointed the founding Course Manager for the inaugural Prolonged Casualty Care Course, preparing forward-deployed Corpsmen to sustain casualties beyond the “Golden Hour” in resource-limited environments and austere terrain. In 2021, USUHS selected HM1 Matthews for one of seven Navy slots for the EMDP2. He is currently enrolled as a graduate student and aims to continue to serve our nation and global community as a physician and Medical Officer in the United States Navy. HM1 Matthews earned a BA in History, Middle Eastern Concentration, from the University of California San Diego in 2014 and worked as an EMT-B and Ocean Lifeguard for the San Diego Fire Rescue Department from 2014 to 2016. Additional current and prior professional qualifications include PHTLS, ABLS, TCCC Instructor, Personal Watercraft Operator for High-Surf Rescues, and AHA BLS Instructor. 

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