Operationalizing Advanced Resuscitative Care: The experience of the Special Operations Resuscitation Team (SORT) Special Operations Medical Association Scientific Assembly (SOMSA) 16 MAY 2018 COL Jay Baker, 528 th Sustainment Brigade (SO) (A) Surgeon CPT Brandon Fetterolf, SORT A Medical Director TCCC Proposed Changes: 2017-4 Add an Advanced Field Care phase to TCCC REBOA Whole blood WBB or CS Type O Low Definitive junctional hemorrhage control (if needed) Intubation Oxygen, assisted ventilation (if needed) Chest Tubes with suction 1
Potentially survivable causes of death 2
Potentially Survivable Hemorrhage 13.5% n = 119 19.2 % n = 171 67.3% n = 598 Truncal Junctional Extremity 3
Potentially Survivable Hemorrhage 19.2 % n = 171 13.5% n = 119 REBOA Whole blood Junctional Advanced hemorrhage Truncal control Intubation Junctional 67.3% Resuscitative Oxygen, assisted Extremity ventilation n Chest = 598 Tubes Carewith suction Golden Hour Re-analysis 2017 Percentage of KIA Reduction Attributable to Each Factor 4
SORT Scalability HOUSE FLIGHT SURG CCRN 61N5P 66H5PM5 SOCM SOCM SOCM 68W4SW1 68W3SW1 68W2SW1 LAB 68K2S PAD XRAY 68G2S 68P2S Capability TRUCK Austere DCR 3 x critical DCR patients 60 DOS CL VIII 3 x intensive care patients 4 x intermediate care beds FLIGHT SURG 61N5P CCRN 66H5PM5 SOCM 68W4SW1 2 x critical DCR patients 2 x intensive care beds SOCM 68W3SW1 SOCM 68W2SW1 4 Total/72 hours 7 Total/72 hours LAB 68K2S PAD 68G2S XRAY 68P2S EMT B SORT CP maintenance Mobility RUCK FLIGHT SURG SOCM 61N5P 68W3SW1 SOCM 68W2SW1 CCRN SOCM 66H5PM5 68W4SW1 1 x critical DCR pt/24 h DCR team augmentation 1 x critical DCR pt/24 h REBOA Houston REBOA Mayo Austere Critical Care Course Prytime trainer at VALEX Expensive equipment Access to models that mimic live procedure Skill level among operators Prytime Trainer during team training cycles Disseminate to all physicians, nurses and medics Cadaver training 5
Walking Blood Bank SORT blood SOP Training lanes (Gryphon Group, VALEX, Mountain Medicine course, training lanes, etc) Incorporate into large training exercise (ie MASCAL) Frequency of training Update SOP Incorporate new JTS blood CPG Continue training lanes (MASCAL, etc) Battlefield Blood Transfusion SORT blood SOP Training lanes (Gryphon Group, VALEX, Mountain Medicine course, training lanes, etc) FDP training Adjusting to various elements Consistency in equipment Update SOP Integrate with new AMEDD blood CPG Continue training lanes (MASCAL, etc) 6
Junctional Hemorrhage Control Schools VALEX Training lanes Gryphon Group (austere, limited resources) Consistency in equipment Looking forward Watch TCCC guidelines for updates Intubation Schools VALEX LTT Training lanes Gryphon Group Emergent intubations OR with anesthesia teams Off duty employment/carolinas 7
Oxygenation (with ventilation as needed) Schools VALEX Training lanes Gryphon Group Mimicry of live scenarios on humans WAMC ICU w/rt and ICU staff Carolinas ABG training Chest Tube (with Suction) Schools LTT VALEX Mimicry of live scenarios on humans Off duty employment Carolinas 8
The Future of ARSOF ARC Teams SORTs FRSTs FY19 ARSOF FRST Scalability CL VIII & Equipment Life Support Requirement & Maneuverability OPS-O O2 or E7 Responsibilities Blood resupply Med log LNO w/ C2 (e.g. SOTF) In Extremis Capability 5 DCR patients/24 hours 8 DCR patients/72 hours 2 DCR patients/24 hours *Capability description: all patients considered critical AR 4-02.25: 2 DCS patients/24 hours 7 Total/24 hours 30/FRST/72 hours 5 DCR patients/24 hours 12/0.5 FRST/72 hours 3-4 DCS patients/72 hours 8 DCR patients/72 hours 2 DCR patients/24 hours 1 major DCS patient/24 hours SURG PA 65D 11-12 Total/72 hours Summation of Capability SURG PA 65D 2 DCS patients/24 hours 3-4 DCS patients/72 hours DCRT 1 DCRT 2 DCST DCST Augmentation OR 68WW120 SURG PA 65D OR 68WW120 1 minor DCS patient/24 hours Multiplier of Capability 9
Conventional FRST ARC Teams? ADMINISTRATIVE DET E7 68W40 FLD MED ASST O2 70B67 RESUS RESUS ER PHYSICIAN 62A00 ER PHYSICIAN 62A00 EMER EMER CARE PRACT 66T00 68W20 SP E4 68C10 EMER 66T00 EMER CARE 68W20 PRACT 68C20 SURG SURG GEN SURG O5 61J00 *Code 50 GEN SURG 61J00 ANES 66F00 ANES 66F00 ORTHO SURG 61M00 ORTHO SURG 61M00 CRIT CARE 66S00 CRIT CARE 66S00 OR 68D20 OR NCO E6 68D30 Brigade Combat Team ARC Teams? MTOE change to BCT Support Battalions Combat Trauma Teams = 1x EM physician + 1x EMPA Lots of medics to fill out the team AMEDD Journal, 2016 10
Questions or comments? 11