1/16/2014 NONE WILL BE TALKING ABOUT NON FDA APPROVED DRUGS WILL LET YOU KNOW WHEN NOT ENDORSING ANY PARTICULAR PIECE OF EQUIPMENT
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1 CUTTING EDGE TACTICAL MEDICINE SECRETS FROM THE BATTLEFIELD Brendan Anzalone, DO, Maj, USAF, MC Emergency Physician Special Tactics Medicine USAF Special Operations Surgical/Critical Care Evacuation Team Clinical Assistant Professor Department of Emergency Medicine University of Alabama at Birmingham This presentation does not represent the views of the United States Government, United States Air Force or the Department of Defense. NONE WILL BE TALKING ABOUT NON FDA APPROVED DRUGS WILL LET YOU KNOW WHEN NOT ENDORSING ANY PARTICULAR PIECE OF EQUIPMENT 1. REMOTE DAMAGE CONTROL RESUSCITATION, BLOOD PRODUCTS AND EMS A PERFECT COMBINATION? 2. FREEZE DRIED PLASMA: A FUTURE PART OF REMOTE DAMAGE CONTROL RESUSCITATION? 3. ICU IN A BAG NOT POSSIBLE? OR IS IT? GEAR TO SUPPORT REMOTE DAMAGE CONTROL RESUSCITATION IN THE FIELD 1
2 TRANSFUSION JAN 2013 SUPP DCR AN EFFORT TO MINIMIZE OR CURTAIL DAMAGE OR LOSS REMOTE = TIME/DISTANCE GAP AN OUT OF HOSPITAL RESCUS STRATEGY INCLUDING BLOOD COMPONENT TRANSFUSION IS NECESSARY 1. RESOLVE IMMEDIATE LIFE THREATS 2. LIMIT IVF WHEN FEASIBLE/PERMISSIVE HYPOTENSION 3. RESUSCITATE WITH BLOOD/FFP/PLT 1:1:1 FASHION 4. CONSIDER TXA/FACTOR VII 5. MOVE TO FRESH WHOLE BLOOD WHEN NEEDED 6. KEEP THE PATIENT WARM 7. NORMALIZE THE PH COAGULOPATHY HYPOTHERMIA ACIDOSIS 1. RESOLVE IMMEDIATE LIFE THREATS 2. LIMIT IVF WHEN FEASIBLE/PERMISSIVE HYPOTENSION 3. RESUSCITATE WITH BLOOD/FFP/PLT 1:1:1 FASHION 4. CONSIDER TXA/FACTOR VII 5. MOVE TO FRESH WHOLE BLOOD WHEN NEEDED 6. KEEP THE PATIENT WARM 7. NORMALIZE THE PH COAGULOPATHY HYPOTHERMIA ACIDOSIS 2
3 JOURNAL OF TRAUMA 2012 VOL 73, NUMBER 2, SUPP 1 ROTARY WING SERVICE LONG TRANSPORT TIMES RURAL HOSPITALS CARRIED THAWED PLASMA AND PRBCS PLASMA FIRST TRANSFUSION PROTOCOL MOBILE BLOOD BANK JOURNAL OF TRAUMA 2012 VOL 73, NUMBER 2, SUPP 1 TRAINED PROVIDERS BLOOD BANK SUPPORT TEMPERATURE CONTROL MECHANISM TO RETURN THAWED PLASMA (5 DAYS) TECHNOLOGY TO SUPPORT 3
4 POINT OF INJURY RDCR RURAL TACTICAL DISASTER EXTRICATION DAMAGE CONTROL SURGERY (DCS) COAGULOPATHY HYPOTHERMIA ACIDOSIS POINT OF INJURY RDCR EMS SUPERVISOR/ROTARY WING/TAC EMS DAMAGE CONTROL SURGERY (DCS) COAGULOPATHY HYPOTHERMIA ACIDOSIS 1. REMOTE DAMAGE CONTROL RESUSCITATION, BLOOD PRODUCTS AND EMS A PERFECT COMBINATION? 2. FREEZE DRIED PLASMA: A FUTURE PART OF REMOTE DAMAGE CONTROL RESUSCITATION? 3. ICU IN A BAG NOT POSSIBLE? OR IS IT? GEAR TO SUPPORT REMOTE DAMAGE CONTROL RESUSCITATION IN THE FIELD 4
5 JOURNAL OF TRAUMA 2006:60:S59-69 FFP FREEZE DRIED PLASMA ABANDONED DUE TO HEPATITIS PRBC S PLT WHOLE BLOOD WWI WWII POST WWII CURRENT CONFLICT WHOLE BLOOD TX FREEZE DRIED PLASMA AS A RESCUS FLUID WHOLE BLOOD FRACTIONATION THERAPY FRACTIONATION WARM FRESH WHOLE BLOOD OTHER COUNTRIES FREEZE DRIED PLASMA 5
6 TRANSFUSION VOLUME 53, JAN 2013 SUPPLEMENT FRENCH MILITARY BLOOD INSTITUTE FREEZE DRIED PLASMA (FDP) k UNITIS DELIVERED TO SUPPORT FRENCH MILITARY OPERATIONS 1994 FORMAL HEMOVIGILANCE PROGRAM (FLYP) OBTAINED FROM <11 DONORS BY APHERESIS/LEUKOREDUCED 2003 /ANTI HLA TESTED 2009/UV TREATED 2010 NO ADVERSE EVENTS SINCE 1994 (1100 USES) OVERSEAS USE NOT US FDA APPROVED JOURNAL OF TRAUMA DEC 2011 VOLUME 71, NUMBER 6 FDP: 2 YR SHELF LIFE/ROOM TEMP STORAGE RECONSTITUTION TIME <6 MIN UNIVERSALLY COMPATIBLE ROLE III AFGHANISTAN CASUALTIES/93 FDP TRANSFUSIONS EASE OF USE/EFFECT COMPARABLE TO FFP/NO ADVERSE EVENTS NOT US FDA APPROVED JOURNAL OF TRAUMA 2013 VOLUME 75, NUMBER 2, SUPPLEMENT 2 ISRAELI EXPERIENCE: FDP WITH FRONT LINE DOCS/MEDICS FIRST USE IN HYPOTENSIVE MVA VICTIM.OUR VIEW THAT IN TRAUMA PTS EXPERIENCING EXTENSIVE HEMORRHAGE, PLASMA SHOULD BE THE RESUSCITATION FLUID OF CHOICE, IN BOTH MILITARY AND CIVILIAN SETTINGS, BOTH IN RURAL AND URBAN POINT OF INJURY CARE, THUS OFFERING POTENTIAL FOR INCREASING THE SURVIVAL OF CASUALTIES AND SAVING LIVES AROUND THE WORLD FDP: GERMAN PRODUCT, 1 DONOR, AB NOT US FDA APPROVED 6
7 1. REMOTE DAMAGE CONTROL RESUSCITATION, BLOOD PRODUCTS AND EMS A PERFECT COMBINATION? 2. FREEZE DRIED PLASMA: A FUTURE PART OF REMOTE DAMAGE CONTROL RESUSCITATION? 3. ICU IN A BAG NOT POSSIBLE? OR IS IT? GEAR TO SUPPORT REMOTE DAMAGE CONTROL RESUSCITATION IN THE FIELD ANN ROYAL COLLEGE OF SURGEONS 1975 Key Points:.miniaturization of diagnostic and treatment aids is required to fulfill the requirement for mobility 7
8 8
9 1. REMOTE DAMAGE CONTROL RESUSCITATION, BLOOD PRODUCTS AND EMS A PERFECT COMBINATION? 2. FREEZE DRIED PLASMA: A FUTURE PART OF REMOTE DAMAGE CONTROL RESUSCITATION? 3. ICU IN A BAG NOT POSSIBLE? OR IS IT? GEAR TO SUPPORT REMOTE DAMAGE CONTROL RESUSCITATION IN THE FIELD 9
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