We are pleased to announce an upcoming educational opportunity. On Thursday, October 14, 2010, the Texas Health Presbyterian Hospital will be hosting a conference titled, “Update on Tactical Medicine Concepts and Controversies.” This is a great opportunity and we will be attending.

Tactical_Medicine_Web_Brochure

Conference Description:
This conference will address those new and innovative interventions, products and techniques whose implementation at the point of wounding (POW) will allow for a more stable and viable patient upon arrival at the tertiary facility and, hence, improved longterm outcome. Though originally designed for the military theater, Tactical Combat
Casualty Care (TCCC) concepts are rapidly being adopted within the civilian medical and law enforcement communities as they are asked to respond to terror incidents at home. Columbine High School, Virginia Tech and terror incidents in Russia and India are only a few examples of the world in which we live. This conference is as relevant to
law enforcement (local and federal) and medical first responders as it is to the Soldiers and Marines on the battlefield. It is also relevant to physicians, nurses and other care providers, both civilian and military, who have a need for familiarity with current medical care techniques in the tactical environment.

We often get questions regarding hemostaics:
Which is the best?
How do they work?
What is the mechanism of action?

The TCCC recommendation of Combat Gauze (TM) has clouded the issue of effectiveness with respect to other available agents. That is to say, there are others on the market that were just as effective in studies that were not chosen. Hopefully, the attached study summarizes the pros and cons of most available agents.

TCCC Hemostatics JRAMC 2010

Below is an excerpt from a lessons learned compilation titled “First to Cut: Trauma Lessons Learned in the Combat Zone.” Though it is geared toward FST surgeons and forward medical providers, some of the lessons are applicable to tactical medics and mountain rescue. The larger take-away point is that the physiology occurring distally to a tourniquet applied for a long duration needs to be considered when changing or loosening, especially in environments where medical care may be limited (e.g., Third World).

“Four Hours of Tourniquet Time”

“26 y.o. male with foot traumatic amputation and
multiple frag wounds to the right leg with a high thigh
field tourniquet in place. Arrived to the CSH with SBP of
100 HR of 120. we had no report on duration of the
tourniquet. We took down the tourniquet and he promptly
coded. We put the tourniquet back up, intubated him and
gave him fluid and bicarb and he came back. We found
out later that the tourniquet had been in place for over 4
hours….”

The use of tourniquets – while rare in civilian trauma is
very common in combat injuries. Tourniquets are the
number 1 instrument that a medic can employ to lower the
KIA numbers. The use of tourniquet with application until
the absence of a distal pulse by default causes distal
ischemia. Release of a functioning tourniquet after several
hours can result in the release of acidic fluid and potassium.
The patient intubated and without a head injury can be
briefly hyperventilated. Before taking down a long
duration tourniquet make sure the patient is well hydrated,
resuscitated, adding an ampule of sodium bicarbonate or
THAM can prophylax against the release of “bad humors”,
lactic acid, and potassium. Also release the tourniquet
slowly – if the rare arrhythmia arises re–employ the
tourniquet and retry after further bicarb and fluid. If the leg
is necrotic remember “life before limb” and perform an
amputation.

Lessons Learned:
–Prolonged tourniquet times can result in the release
of acidotic fluid and hyperkalemia
–Perform 4 compartment fasciotomy with all lower
extremities with significant tourniquet times

Read the rest of this entry »

After reviewing the many submissions for our first contest, 101 Ways to Use a Triangular Bandage, we have selected our winners. Due to the fact that two contestants submitted outstanding submissions, we decided to award two prizes. Our first winner, for the shear volume of ideas, is Lee Whitehead and he will receive $200 worth of Tac Med Gear. Our second winner, who submitted the most unique ideas that range from medical uses to survival, comes to us from Belgium (name withheld for OPSEC), and he will receive the same prize.

Thank you all for your submissions. We will begin posting videos of them over the next few months. If you have any other ideas for contests, let us know.

Tac Med Team

Chest decompression for non-medics is a sticky subject. Recent observations overseas have seen an increase in improper location medially when inserting the needle. The causes of the high rate of improper placement are difficult to determine (i.e., environment, visibility, etc.) and have led to some medical directors prohibiting the procedure for non-medics within the military and LEO teams. However, the below study illustrates that proper initial training leads to high retention rates, thereby making this a skill that ought to remain at the operator level.

Abstract
Introduction: Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.

Methods: After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.

Results: Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.

Conclusions: Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration
for at least six months.