Andrew D. Fisher

Is it true that combat zone documentation is non-existent? The short answer is that documentation not only happens, but it is command-directed. Extensive advancements in trauma science have come from the DODTR and other modules, including the PHTR. The earliest studies in the recent generation on balanced transfusions started in the DODTR. More advancements, including tourniquets, etc. were all based out of the deployed data collection. There is a US Central Command mandate to complete JTS and TCCC forms. That said, our data collection needs improvement... a lot. You can't improve what you don't measure. You can't measure what you don't document. A recent systematic review found that there is insufficient data to guide which triage system is most reliable for MASCAL events. The reason for this is garbage data. Better data are needed, and so your MASCAL preparation planning should include documentation methods. Here are some methods to consider: -Have non-medical personnel serve as scribes (including administrators) -Wear body cams and extract the data afterward -Obtain voice recognition software that works with mobile technology pubmed.ncbi.nlm.nih.gov/3979… pubmed.ncbi.nlm.nih.gov/2721… pubmed.ncbi.nlm.nih.gov/3660… pubmed.ncbi.nlm.nih.gov/3444… PMID: 39792184, 36607303, 27215873, 34449860 #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #data #research #army #armymedicine #armyemdoc #trauma #military #navy #airforce #marines #combat #medx #medtwitter

Does dabbling in LTOWB work for resuscitation of children in hemorrhagic shock provide benefit? Our paper published today in @JTraumAcuteSurg sought to answer that. We wanted to know the proportion of LTOWB of the total product received that needs to be targeted to gain survival benefit during the first 24 hours. We found that targeting a floor of 30% LTOWB by total product volume conferred a survival benefit. 6-hours = OR 1.85 (1.02-3.38) 12-hours = 2.09 (1.20-3.36) 24-hours = 1.80 (1.06-3.08) doi.org/10.1097/ta.000000000… #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #blood #trauma #kids #children #pediatrics #medx #medtwitter

When resuscitating, can you dabble in whole blood, or do you need to go all in? This paper by @fisherad1 in @AmJSurgery this month sought to answer that. He looked at increasing fractions of whole blood as a proportion of total products administered in adults. After adjusting for confounders, there was no difference in survival based on increasing proportions at 6h. However, as the proportions increased, the survival also increased at 24h. This suggests 2 things: -There is less benefit to dabbling in whole and you likely gain benefit with incorporating more into your resuscitation strategy -More interesting, IMO, is that at 6h it probably doesn't matter what you give them as long as you give them volume... but giving them volume of the less desirable stuff catches up at 24h. So, just because you see their numbers get better on the monitor right away, doesn't equate to actually fixing the problem -- their tissue oxygen debt and coagulopathy. americanjournalofsurgery.com… DM me for the full paper #emergency #emergencymedicine #criticalcare #icu #erlife #iculife #science #army #armymedicine #armyemdoc #resuscitation #research #data #trauma #blood #medx #medtwitter