MILITARY SOF CONCURRENT SESSION

Transcription

1 MILITARY SOF CONCURRENT SESSION LTC(P) Cord W. Cunningham, MD, MPH, FACEP EMS Physician SOF Truths 1

2 AGENDA SOF Truths SOF Medical Support LTC Cord Cunningham, MD, MPH Advanced Field Care COL Jay Baker, MD 528th Surgeon Expeditionary Combat Medic (ECM) SFC Joey Hernandez, CPHM Prehospital Initiatives Ranger Style LTC Ethan Miles, MD, 75th Break Surgical Support During OIR Syria MAJ Julie Rizzo, MD Evaluating Host Nation Hospitals for Medical Contingency Planning MSG Donald Hovander, 18D; MAJ JR Pickett, BN Surg, 2/19 th SFG(A) Exped Resusc Surg Teams (ERST) MSG Rich Jarrett, NCOIC CPHM Lunch Update on Pararescue Medical Operations LtCol Stephen Rush, M.D., USAF Pararescue Medical Director Use of Pediatric BVM for Adult Patients? Jeffrey Siegler, MD, EMT-P D Refresher Course SFC Paul Loos, 18D Break Burn Care in the Austere Environment MAJ Julie Rizzo, MD Peds Prehospital Trauma for the SOF Provider LTC Guyon Hill, MD BATDOK (Battlefield Assisted Trauma Distributed Observation Kit) Gregory Burnett; LtCol John Dorsch,MD Unless someone like you cares a whole awful lot, nothing is going to get better. Its not. Dr Suess 2

3 SOF TRUTHS FOR SOF MEDICAL SUPPORT HUMANS ARE MORE IMPORTANT THAN HARDWARE LTC(P) Cord W. Cunningham, MD, MPH, FACEP EMS Physician Disclaimer/COI Opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the Department of the Army or the Department of Defense. No disclosures 3

4 3 Main Take Home Points NCTH is still the largest cause of prehospital mortality Civilian GME programs do not meet SOF or expeditionary combat casualty needs Knowledge products and training are just as important as device development Understanding me Heretically refusal WRT legal scope of practice Don t get dead(create another cax) or hasten death Make the blood go round & round Make the air go in and out Treat pain and ease suffering Hand off better than you found it 4

5 Agenda Background Walker Dip Prehospital Importance Prolonged Care Surgical Task Shifting Conclusion/Discussion Please ask questions at any point Lessons Learned? 5

6 We are going to repeat the same mistakes we have made before. We are going to think our doctors are trained. They are not going to be trained. You have to just pray your son or daughter or grand-daughter is not the first casualty of the next war. Pray they come in about the year five mark After a short time, we received one seriously wounded man with a sucking chest wound and he was losing a lot of blood. We tried to seal the chest wound and gave him plasma. We only had a limited amount of plasma. At this time, I realized that the other four medics who were working in the aid station did not know how to mix and give plasma. 6

7 Prehospital Importance Eastridge BJ, Mabry RL, Seguin PG, et al. Death on the battlefield ( ): implications for the future of combat casualty care. Journal of Trauma, Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on the battlefield: causation and implications for improving combat casualty care. Journal of Trauma, (Suppl 1):4-8. Time to Capability Biggest opportunity to save lives is prehospital Rapid transport is important but timely care delivery such as TCCC & DCR was vital 7

8 Time to capability Prehospital Blood Txfn 8

9 Facts/Assumptions MDMP Facts: statements of known data concerning the situation, including enemy and friendly dispositions, available troops, unit strengths, and material readiness. Assumptions: suppositions about the current or future situation that are assumed to be true in the absence of facts Valid: Likely to be true Necessary: planning cannot continue without it Facts/Assumptions Facts: GME completion does not fully prepare for deployed case mix For majority MTF case load does not maintain readiness In Early Entry Operations Role 3 will not be fully established Medical operations are rarely the Main Effort The current inventory of trauma surgeons and trauma proficient surgeons is not adequate for the A2AD environment Assumptions: Obtaining skills and knowledge for deployment trauma treatment can be done without GME/MTF experience Some NCTH can be temporized without DCS beyond golden hour With proper training non-surgeons can treat some NCTH 9

10 Prolonged Care Prolonged Care vs Prolonged Field Care Prolonged Care(PC): holding patients in locations where the current system(s) in place were not designed to care for patients with these conditions beyond the designated evacuation timelines Prolonged Field Care(SOCOM PFC Working Group): field medical care, applied beyond doctrinal planning time-lines, by a Special Operations Combat Medic (SOCM) or higher, in order to decrease patient mortality and morbidity, utilizes limited resources, and is sustained until the patient arrives at an appropriate level of care. Prolonged Prehospital Care(UK def): covering those techniques suitable for use in the prehospital emergency care clinical phase when using the application of additional techniques in order to sustain the casualty if any component of the (+2) medical planning guideline is likely to be exceeded. Delivery of PC will require the medical techniques, skills and capabilities required to hold the patient for a protracted period of time. "Prolonged Care in Support of Conventional Military Forces Capabilities Based Assessment." U.S. Army Medical Dept. Center and School Capability Development Integration Directorate, United States Army Health Readiness Center of Excellence. JBSA, Fort Sam Houston, TX, 78234,

11 Capability Gaps 1. Army units lack the capability to provide prolonged care (PC) when evacuation is delayed to decrease patient mortality and morbidity in 100% of patients with survivable wounds, injuries, and illnesses. 2. Army units lack the capability to manage casualty response events within operational scenarios that include delayed evacuation. 3. Army units lack the capability to triage injured or ill Soldiers in the face of limited resources in order to maximize collective and individual benefits. Triage-Treat-Temporize-Transport "Prolonged Care in Support of Conventional Military Forces Capabilities Based Assessment." U.S. Army Medical Dept. Center and School Capability Development Integration Directorate, United States Army Health Readiness Center of Excellence. JBSA, Fort Sam Houston, TX, 78234, Enhanced(Expeditionary) Combat Medic Functional Solution Analysis." U.S. Army Medical Dept. Center and School Capability Development Integration Directorate, United States Army Health Readiness Center of Excellence. JBSA, Fort Sam Houston, TX, 78234, Prolonged Care 11

12 Master the basics first, then Pushing the Envelope 12

13 Surgical Task Shifting Movement of surgical tasks to non-surgeon clinicians and non-clinician providers Used extensively in Africa and other remote areas to address surgeon shortages Training and Sustaining are both issues Provider roles You are clearly not a surgeon LtCol Zakaluzny If the risk of the mission requires surgical support it should be placed where it is needed COL Keenan Medics are not doctors and doctors are not medics SGM(ret) Hetzler 13

14 Literature GPs in Niger (Sani et al., 2009) 3 month curriculum operative experience over 9 months w/ EXLAP, emergent surgical mortality rate was 10.9% compared to 9.25% when performed by traditionally trained general and obstetric surgeons at the referral centers Systematic review surg care by non-surgeons(hoyler et al.,2015) 43% of non-obstetric laparotomies performed Often without formalized surgical training 3 Main Take Home Points NCTH is still the largest cause of prehospital mortality Civilian GME programs do not meet SOF or expeditionary combat casualty needs Knowledge products and training are just as important as device development 14

15 New JTS Website Conclusion/Discussion/Questions SOLIC, DUE, & A2AD will require more NCTH support than current surgeon inventory Any increase in capability requires significant sustainment Time to capability is paramount TCCC saves lives/focus on the basics Sua Sponte RLTW 15