The OFFICIAL Journal of the Special Operations Medical Association.
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First Blood: Fixing American Trauma Care
October 2017
Overhauling how citizens and medical providers respond to trauma, as well as how they collect and store blood, could save thousands of lives annually.
COL (Ret) Russ Kotwal inducted into Ranger Hall of Fame
July 2021
Colonel (Retired) Russ Kotwal, M.D., M.P.H., is inducted into the Ranger Hall of Fame for distinguished and continued service to our country, and for dedicating his life and career to the values set forth in the Ranger Creed. COL(R) Kotwal is a legend in the 75th Ranger Regiment and is recognized for wide-ranging excellence in military medicine. He has spearheaded several life-saving initiatives within the special operations medical community, including the Pre-Hospital Trauma Registry. COL(R) Kotwal is responsible for establishing, implementing and progressing Tactical Combat Casualty Care. Through countless studies, training, and establishing new standard operating procedures, COL(R) Kotwal put Ranger Medicine at the forefront of combat medicine. COL(R) Kotwal is responsible for establishing a medical system that has saved anyone who could be saved in combat. His leadership and continual pursuit of perfection when confronted with the no fail task of saving Ranger lives has set the example for others to follow. He also established the Ranger Athlete Warrior Program, centralizing... human performance training, tracking and rehabilitation. This effort synchronized rehabilitation efforts with physical training programs and streamlined wounded and injured Rangers return to duty. His operational assignments include four years with the 25th Infantry Division, nine years with the 75th Ranger Regiment, and two years with the U.S Army Special Operations Command. He has deployed to combat twelve times with the Rangers, nine times to Afghanistan and three to Iraq. He has conducted hundreds of combat ground and air missions as the senior medical provider for which he has received five Bronze Star Medals, two Joint Service Commendation Medals for Valor, and two Combat Jump Stars. COL Kotwal retired in 2014 after 28 years of dedicated service to our nation. In his last assignment, he served as the Deputy Command Surgeon for the U.S. Army Special Operations Command. He continues to share his vast medical knowledge as an Independent Medical Consultant. The indelible mark COL(R) Kotwal has left on Rangers, Ranger Families as well as the influence he has made through many medical initiatives, influence, and leadership have and will continue to save lives for years to come.
August 2021 Feature Article
23.4% Hypertonic Saline: A Tactical Option for the Management of Severe Traumatic Brain Injury With Impending or Ongoing Herniation
Summer 2021
DeSoucy ES, Cacic K, Staak BP, Petersen CD, van Wyck D, Rajajee V, Dorsch J, Rush SC. 21(2). 25 - 28. (Journal Article)
Abstract
There are limited options available to the combat medic for management of traumatic brain injury (TBI) with impending or ongoing herniation. Current pararescue and Tactical Combat Casualty Care (TCCC) guidelines prescribe a bolus of 3% or 5% hypertonic saline. However, this fluid bears a tactical burden of weight (~570g) and pack volume (~500cm3). Thus, 23.4% hypertonic saline is an attractive option, because it has a lighter weight (80g) and pack volume (55cm3), and it provides a similar osmotic load per dose. Current literature supports the use of 23.4% hypertonic saline in the management of acute TBI, and evidence indicates that it is safe to administer via peripheral and intraosseous cannulas. Current combat medic TBI treatment algorithms should be updated to include the use of 23.4% hypertonic saline as an alternative to 3% and 5% solutions, given its effectiveness and tactical advantages.
Keywords: traumatic brain injury; TBI; military medicine; hypertonic saline; Tactical Combat Casualty Care; TCCC
Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States Servicemembers injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events.
This report documents the remarkable decrease in casualties killed in action during the wars in Iraq and Afghanistan and the role of the Joint Trauma System, the CoTCCC, and the TCCC Working Group in helping to make that happen. It also outlines a clear and comprehensive vision for a National Trauma System that will enable the civilian and the military sectors to work in concert to help prevent ALL potentially preventable deaths in trauma victims.
Download a free PDF copy of the IOM ReportWhat Our Readers are Saying
I just finished reading the fall edition of the JSOM and I am completely blown away!!!! It is absolutely packed with exceptional and relevant information that without a doubt, will assist SOF Tactical Health Care professionals in providing relevant and evidence based patient care. Thank you for providing what I consider a "World Class Medical Journal". The journal itself and the website have become my primary resource for knowledge in tactical medicine."
Robert M. Miller
North American Rescue
Chief Innovation Officer
"There is no peer-reviewed academic resource that equals the Journal of Special Operations Medicine for support of the medical and veterinary lead in Stabilization, Security, Transition and Reconstruction (SSTR) operations, combat and field medicine, and adaptation of Tactical Combat Casualty Care into Tactical Emergency Casualty Care for the law enforcement and emergency management community in 195 UN member countries. JSOM is a valuable resource as we continue the Millennium Medicine Project, targeting the global population that lacks access to basic surgical services and providing crisis management, security, and defense support in this demographic."
Stephen M. Apatow
President, Humanitarian Resource Institute
(UN:NGO:DESA) and H-II OPSEC: Defense Support:
Humanitarian and Security Operations
"Military units that have trained all of their members in Tactical Combat Casualty Care have documented the lowest incidence of preventable deaths among their casualties in the history of modern warfare - and JSOM is the first journal to publish every new change in TCCC."
Frank K. Butler, MD
Chairman, Committee on Tactical
Combat Casualty Care (CoTCCC)
"The past 30 years has brought an amazing professionalization of the specialty of Tactical Emergency Medical Support (TEMS). As new standards are set and the world faces increasingly complex security challenges, it is critical that the front line medical providers supporting military, intelligence, and law enforcement operations have a mechanism to expand their knowledge and share best practices. The Journal of Special Operations Medicine offers civilian readers access to the most cutting edge developments in the field including updates on Tactical Emergency Casualty Care (TECC), the National TEMS Imitative and Council (NTIC), and combat lessons learned. JSOM is the one-stop shop for best practice and future advancements in civilian TEMS. One of the unifying principles across humanitarian, expedition and disaster response medical operations is the ability to make complex decisions in uncertain environments. The Journal of Special Operations Medicine is one of the most unique platforms for experts to convey lessons learned and relevant scientific advances across specialties that historically have little interaction. Whether you work for Doctors Without Borders, a DMAT, or provide medical support for expeditions in austere environments, Journal of Special Operations Medicine is your journal."
David W. Callaway, MD
Director, Division of Operational and Disaster Medicine
Operational Medical Director, Carolinas MED-1
Co-Chairman, The Committee for Tactical Emergency Casualty Care (C-TECC)
Civilian Vice President, Special Operations Medical Association (SOMA)