A hybrid simulator model for the control of catastrophic external junctional haemorrhage in the military environment.

Katarina Silverplats,Anders Jonsson,Lars Lundberg

doi:10.1186/s41077-016-0008-z

Katarina Silverplats, Anders Jonsson + Show 1 more

Open Access

https://doi.org/10.1186/s41077-016-0008-z

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Abstract

Catastrophic haemorrhage from extremity injuries has for a long time been the single most common cause of preventable death in the military environment. The effective use of extremity tourniquets has increased the survival of combat casualties, and exsanguination from isolated limb injuries is no longer the most common cause of death. Today, the most common cause of potentially preventable death is haemorrhage from the junctional zones, i.e. the most proximal part of the extremities, not amenable to standard tourniquets.Different training techniques to control catastrophic haemorrhage have been used by the Swedish Armed Forces in the pre-deployment training of physicians, nurses and medics for many years. The training techniques include different types of human patient simulators such as moulage patients and manikins. Preferred training conditions for the control of catastrophic haemorrhage include a high degree of realism, in combination with multiple training attempts.This report presents a new hybrid training model for catastrophic external junctional haemorrhage control. It offers a readily reproducible, simple and inexpensive opportunity to train personnel to deal with life threatening catastrophic junctional haemorrhage. In particular, this model offers an opportunity for non-medical military personnel in Sweden to practice control of realistic catastrophic haemorrhage, with multiple training attempts.

Highlights

The medical challenge Most battlefield casualties die of their injuries in the prehospital environment
Preferred training conditions for the control of catastrophic haemorrhage include a high degree of realism, in combination with multiple training attempts
A hybrid model for catastrophic external junctional haemorrhage At Swedish Armed Force Centre for Defence Medicine (SWE CDM) we have developed a hybrid model based on a realistic model made for external haemorrhage training by the British Defence Medical Services, originally described by Moorhouse et al [32]

Summary

Introduction

The medical challenge Most battlefield casualties die of their injuries in the prehospital environment. The widespread use of effective extremity tourniquets, in combination with novel haemostatic agents, has decreased the incidence of death from exsanguination due to extremity injuries and non-compressible wounds [5,6,7,8, 21, 22], though the reasons for improved survival are multi-factorial [23].The new challenge is to control haemorrhage from body areas too proximal for extremity tourniquets. In Sweden, military medical personnel are trained how to respond to the most common cause of preventable battlefield fatalities, including extremity and junctional zone haemorrhage. Before the student starts using the model, an instructor demonstrates how to apply manual pressure and haemostatic gauze to stop the bleeding and describes the haemostatic agents used, how they work and why it is important to stop or control the haemorrhage at the prehospital location

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