NMCP Combat Trauma Research Group

1. NMCP Combat Trauma Research Group Lanny Littlejohn, MD CDR MC (FS/DMO) USN Research Director, CTRGMedical Director, TCCC NMCP Dept of Emergency Medicine

2. Group Structure and Mission • Composed of 3-4 staff EM physicians • 1-2 deployed or in fellowship at any given time • Residents interested in contributing to preclinical literature • Three areas of focus • Prehospital and early resuscitative phase • Bridging between preclinical and clinical via protocols with fidelity to actual casualty Tx • Support the mission of the residency program • Wide range of research questions so less expertise in any one area.

3. Recent and upcoming protocols • 4 hemostatic agent studies completed • Henao • Kozen • Devlin • Littlejohn • 1 hemostatic agent study planned (May 2012) • Supraglottic airway and TQ study just completed in TCCC class • Vented Chest Seals • HBOC/HTS ongoing • Arginine Vasopressin • Tranexamic Acid

4. Hemostatic Agents • Experience primarily in the Alam model WRT injury • Open and limited access models • CELOX equal efficacy (QC and Hemcon) open model • All agents similar if pressure dressing appropriately used • Kerlix effective in small wounds with firm packing • Adopted Kheirabadi model after standardization meeting (upcoming protocol)

5. The Effectiveness of Navy Hospital Corpsman in Applying TCCC Recommended Prehospital Tourniquets under Simulated Combat Stress(CIP # 2011-0074) Richard H. Schreckengaust, MD LCDR MC (UMO/DMO) USN Emergency Medicine Resident NMCP Dept of Emergency Medicine

6. Design Timeline Baseline End of Training Field Test Training Day1 Day4 Day5 • Classroom Setting • Initial Briefing • Minimal Stress • Classroom Setting • Minimal Stress • Field Setting • High Stress • Obstacle Course • Care under Fire • Flak, Helmet, Mask • Randomized, Cross-Over Design • Each HM applied CAT and SoftT • At each Timepoint • Dependent Variables • Time • Pulse • Placement

7. Results - Pulse • CAT v SOFT-T* • 30% diff (2x rate) • Training Effect* • 15% improvement • Care Under Fire • 5% decrement (*p < .05)

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