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Med J (Ft Sam Houst Tex) ; (PB 8-21-04/05/06): 3-8, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34251658


INTRODUCTION: The Joint Readiness Training Center (JRTC) offers a laboratory for study of combat casualty care delivery during brigade-sized collective training exercises. We describe the casualty outcomes during largescale combat operations as part of a JRTC rotation. METHODS: During JRTC rotation 20-02, 2/4 Infantry Brigade Combat Team (IBCT) participated in force on force operations as part of a joint and multinational task force. Medical assets available included a Role II associated with the Brigade Support Medical Company and Role I facilities associated with six subordinate battalion elements. Observers, coaches, and trainers (OCTs) categorized all casualties as killed in action (KIA) or wounded in action (WIA). OCTs categorized WIA casualties as died of wounds (DOW) based upon time elapsed from time of injury to transportation to successive roles of care within time standards, dependent upon the severity of injuries. We portrayed our DOW rates using descriptive statistics. RESULTS: Force on force operations spanned 14 days. The task organization comprised 3,820 persons. Casualties included 642 KIA and 1061 WIA. Of the WIA, 502 (47.3%) dies from their wounds. The primary reason for DOW was evacuation delay from point of injury (POI) to military treatment facility (MTF) (443 casualties, 88.2%). An additional 40 casualties DOW at the Role 1 (8.0%) and 10 died at Role II (2.0%). Nine casualties (1.8%) DOW due to improper care rendered. DISCUSSION: Casualty DOW during simulated large-scale combat operations are overwhelmingly due to evacuation delays from POI. Medical readiness for near-peer force on force operations depends upon shared understanding across medical and non-medical personnel of casualty movement through echelons of care on the battlefield.

Serviços Médicos de Emergência , Medicina Militar , Militares , Serviços de Saúde , Humanos , Organizações
Med J (Ft Sam Houst Tex) ; (PB 8-21-04/05/06): 9-13, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34251659


INTRODUCTION: The US Army's transition from counterinsurgency operations to preparation for large-scale combat operations is likely to bring unique access to care challenges on the battlefield. Ruggedized computer systems exist that allow forward medical personnel to establish telehealth connections with rear-based specialists. We describe our use of one such device during simulated force on force operations at the Joint Readiness Training Center (JRTC). METHODS: Our infantry brigade combat team brought a telehealth device to JRTC 20-02. The device comprised a mobile laptop and peripheral medical devices. We used the Warfighter Information Network-Tactical Increment 2 Tactical Communications Node (TCN) to establish communication between the device and external entities. We sought to establish connectivity in the Fort Polk, LA, cantonment area as part of reception, staging, onward movement, and integration operations. RESULTS: We successfully executed video calls from the field utilizing the telehealth device at the JRTC rear aid station and the local military treatment facility on Fort Polk, LA. We also executed calls to our home station military treatment facility on Fort Carson, CO. Each of these calls lasted approximately five minutes with sustained high-quality video and audio feeds. CONCLUSIONS: Our experience provides proof of concept that telehealth may enable rear-based medical personnel to expand the medical capabilities of medics based forward in the battlespace. Telehealth devices may prove feasible for use with strictly tactical communications architecture in the kinetic setting of large scale combat operations.

Telemedicina , Comunicação
Mil Med ; 2020 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-33242098


INTRODUCTION: The Prehospital Trauma Registry (PHTR) captures after-action reviews (AARs) as part of a continuous performance improvement cycle and to provide commanders real-time feedback of Role 1 care. We have previously described overall challenges noted within the AARs. We now performed a focused assessment of challenges with regard to hemodynamic monitoring to improve casualty monitoring systems. MATERIALS AND METHODS: We performed a review of AARs within the PHTR in Afghanistan from January 2013 to September 2014 as previously described. In this analysis, we focus on AARs specific to challenges with hemodynamic monitoring of combat casualties. RESULTS: Of the 705 PHTR casualties, 592 had available AAR data; 86 of those described challenges with hemodynamic monitoring. Most were identified as male (97%) and having sustained battle injuries (93%), typically from an explosion (48%). Most were urgent evacuation status (85%) and had a medical officer in their chain of care (65%). The most common vital sign mentioned in AAR comments was blood pressure (62%), and nearly one-quarter of comments stated that arterial palpation was used in place of blood pressure cuff measurements. CONCLUSIONS: Our qualitative methods study highlights the challenges with obtaining vital signs-both training and equipment. We also highlight the challenges regarding ongoing monitoring to prevent hemodynamic collapse in severely injured casualties. The U.S. military needs to develop better methods for casualty monitoring for the subset of casualties that are critically injured.