An Analysis of Conflicts Across Role 1 Guidelines.

Autor: Johnson SA; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-7767, USA., Lauby RS; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-7767, USA., Fisher AD; Medical Command, Texas Army National Guard, Austin, TX 78703-1222, USA.; UNM School of Medicine, Department of Surgery, Albuquerque 87106, New Mexico., Naylor JF; Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA., April MD; 2nd Stryker Brigade Combat Team, 4th infantry division, Fort Carson, CO 80913, USA., Long B; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA., Schauer SG; US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234-7767, USA.; Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.; Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Jazyk: angličtina
Zdroj: Military medicine [Mil Med] 2022 Mar 28; Vol. 187 (3-4), pp. e263-e274.
DOI: 10.1093/milmed/usaa460
Abstrakt: Introduction: Role 1 care is vital to patient survival and includes many echelons of care from point-of-injury first aid to medical attention at battalion aid stations. Many guidelines are written for Role 1 care providers to optimize care for different scenarios. Differences in the guidelines lead to confusion and discrepancies between the types of treatment medical care providers provide. Although the guidelines were written for different areas of care, uniformity between the guidelines is needed and will lead to a reduced mortality rate.
Materials and Methods: It was determined that the Tactical Combat Casualty Care Guidelines, Prolonged Field Care Guidelines, Joint Trauma System Clinical Practice Guidelines, and Standard Medical Operating Guidelines from medical evacuation were the military medical guidelines most relevant to Role 1 care. These Guidelines were compared side by side to determine the differences between them.
Results: Although the guidelines were largely similar, many major differences were found between them. Our online tables contain large inconsistences between guidelines including direct contradictions in conversion of junctional tourniquets and the administration of tranexamic acid.
Conclusions: Role 1 care is vital to patient survival, including care from point of injury to battalion aid stations, but the guidelines available to instruct this care and the guidance on which personnel should provide this care are conflicting. This lack of clarity and consistency may adversely impact treatment outcomes. The reduction or elimination of conflicting information across the various guidelines, augmentation of guidance for pediatric care, more specific guidance for unique levels of care, and clearer delineation of the Role 1 phases of care (as well as which guidelines are most appropriate to each) should be considered as urgent priorities within the military medical community.
(Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze: MEDLINE
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