Tactical Combat Casualty Care Maritime Scenario: Shipboard Missile Strike.

The types of injuries seen in combat action on a naval surface ship may be similar in many respects to the injuries seen in ground combat, and the principles of care for those injuries remain in large part the same. However, some contradistinctions in the care of combat casualties on a ship at sea must be highlighted, since this care may entail a number of unique challenges and different wounding patterns. This paper presents a scenario in which a guided missile destroyer is struck by a missile fired from an unmanned aerial vehicle operated by an undetermined hostile entity. Despite the presence of casualties who require care, the primary focus of a naval vessel that has just been damaged by hostile action is to prevent the ship from sinking and to conserve the fighting force on board the ship to the greatest extent possible. The casualties in this scenario include sailors injured by both blast and burns, as well as a casualty with a non-fatal drowning episode. Several of the casualties have also suffered the effects of a nearby underwater explosion while immersed. Challenges in the care of these casualties include delays in evacuation, the logistics of obtaining whole blood for transfusion while at sea, and transporting the casualties to the next higher level of care aboard a Casualty Receiving and Treatment Ship. As the National Defense Strategy pivots to a focus on the potential for maritime combat, the medical community must continue to maintain readiness by preparing fo.

TCCC Guidelines Comprehensive Review and Edits 2020: TCCC Guidelines Change 20-05 01 November 2020.

Based on careful review of the Tactical Combat Casualty Care (TCCC) Guidelines, the authors developed a list of proposed changes and edits for inclusion in a comprehensive change proposal. To be included in the proposal, individual changes had to meet at least one of three criteria: 1. The change was primarily tactical, operational, or educational rather than clinical in nature. 2. The change was a minor modification to the language of an existing TCCC Guideline. 3. The change, though clinical, was straightforward and noncontentious. The authors initially presented their list to the TCCC Collaboration Group for review at the 11 August 2020 online virtual meeting of the Committee on Tactical Combat Casualty Care (CoTCCC). Based on discussions during the virtual meeting and following revisions, a second presentation of guideline modifications was presented during the CoTCCC session of the online virtual Defense Committee on Trauma meeting on 02 September 2020. The CoTCCC conducted voting on the guideline changes in early October 2020 with subsequent inclusion in the updated TCCC Guidelines published on 01 November 2020.1.

A Multimodal Evaluation of an Emergency Department Electronic Tracking Board Utility Designed to Optimize Stretcher Utilization.

Objectives The primary objective of this study was to evaluate the impact of an electronic tracking board feature encouraging staff to prompt optimal patient location on total stretcher time (TST) amongst patients moved to a chair in an internal emergency department (ED) waiting room. As a secondary objective, we also sought to identify facilitators and barriers to the tool's use amongst the ED staff. Methods Using an administrative database, a retrospective cohort design was used to compare TST between visits where the tool was used and not used amongst patients relocated from initial assessment space to a chair over an 11.5 month period. A mixed-methods design was used to investigate facilitators and barriers to the tool's use amongst the ED staff. Response proportions were used to report Likert scale questions; thematic analysis was used to code themes. Results A total of 56,852 patients met the inclusion criteria and were moved to a chair. The tool was used 4,301 times, with "OK for chairs" selected for 3,917/56,852 (6.9%) patients and "not OK for chairs" selected 384/56,852 (0.7%) times. Patient characteristics were similar between both groups. Median interquartile range (IQR) TST amongst patients moved to a chair via the prompt was shorter than when the prompt was not used (148.2 (112.6) mins vs 154.4 (115.4) mins, p = 0.005). A total of 125 questionnaires were completed; 95% of staff were aware of the tool and 70% agreed/strongly agreed the tool could improve ED flow. Commonly reported physician barriers to use were forgetting to use the tool; common nursing barriers were lack of chair space and increased workload. Conclusions Despite low function use, prompt use was associated with reduced TST amongst ED patients relocated to a chair.

TCCC Guidelines Comprehensive Review and Update: TCCC Guidelines Change 16-03.

Based on careful review of the Tactical Combat Casualty Care (TCCC) Guidelines, the authors developed a list of proposed changes for inclusion in a comprehensive change proposal. To be included in the proposal, individual changes had to meet at least one of three criteria: (1) The change was primarily tactical rather than clinical; (2) the change was a minor modification to the language of an existing TCCC Guideline; and (3) the change, though clinical, was straightforward and noncontentious. The authors presented their list to the TCCC Working Group for review and approval at the 7 September 2016 meeting of the Committee on Tactical Combat Casualty Care (CoTCCC). Twenty-three items met with general agreement and were retained in this change proposal.