ROC Data and the Golden Hour

[medic45]

Here is a link on some of the ongoing ROC research:

https://roc.uwctc.org/tiki/tiki-read_article.php?articleId=139

For discussion.

 

[CombatDoc]

Current NATO guidelines are 10-1-2. 10 min to initial lifesaving treatment (ie Combat First Aid), 1 hour to Damage Control Resuscitation, 2 hours to Damage Control Surgery. The Golden Hour has become the Golden Two Hours, in essence.

 

[MedCorps]

I think the crux of the 10-1-2 model really sits in the 10. 

We are providing a high level of care almost instantaneously after a trauma occurs.  With self-aid, buddy aid (first aid, combat first aid, TCCC) and forward Med A / Med Tech care the average service member who is injured stands a much better chance then a civilian in a similar situation of making it to damage control resus (DCR) and DCS.

A week ago I received a really good briefing on the direction the future field force is going. The Working Group has just finished off iteration #2 and is moving to #3 in October time fame. If everything works out according to plan you will see the scope of DCR increased in our updated doctrine and field TO&E.  This along with critical care transport (ground or forward air evacuation) from DCR to DCS along with the changes to Role 2B and 2E care will really build on the lessons learned by the CF H Svcs Gp and NATO in Afghanistan / Iraq.

MC

 

[medic45]

Will the change in doctrine lead to changes in TO&E or is it purely a doctrine change at this time?

 

[MedCorps]

It is both.  The CF H Svcs Gp field doctrine is being updated concurrently with the Future Field Force Working Group and some trials and evaluations which will be seen on some upcoming exercises in 2016.

You are likely to see some TO&E changes at the three field ambulances and at 1 Canadian Field Hospital. The higher-level doctrine will likely come out before the TO&E changes, which makes sense given the complexity at changing TO&E's and the fact the approved doctrinal principals should guide procurement and force employment.

Some of this is the result of the changes in health services doctrine in NATO and the changes to the NATO concept of Role 1, Role 2 and Role 3 which Canada needs to bring themselves in line with. Other factors are lessons learned from recent conflicts, changes to Canadian Army force structures (Force 2013), changes to tactical aviation force employment doctrine (Force 2017) and the desire to provide a higher level of care further forward.

If I hear anything I will let you know.  If you have any questions let me know and I can ask around.  I know a number of people on the Working Group.

MC

 

[CombatDoc]

I participated in ROC with Toronto Rescu:
http://www.emergencymedicine.utoronto.ca/research/ptmr/CS/ROC/rescunet.htm

Has the CAF done a similar study?

CAF has access to the Joint Theatre Trauma Registry, a U.S. Led trauma registry. Furthermore, many of our specialists  either use data from JTTR or participate in ongoing research trials. Much of the recent research changes to blood product administration (1:1:1), for example, was driven by NATO's collective combat trauma experience.

 

[CombatDoc]

Will the change in doctrine lead to changes in TO&E or is it purely a doctrine change at this time?

Any changes in TO&E would come from internal reallocation of positions. It is vanishly improbable that these changes to doctrine would increase the number of positions available to H Svcs.

 

[Cantthinkofanything]

I feel that this study does little to shed light on what is already well known within the trauma community.  Interventions and delivery of the patient within "x" amount of time only aids in the survival of an extremely small amount of patients.  The obvious intervention being surgery.  The surgical aspect of this time frame should be what is in question when it comes to survival rates.  The numbers identify transport to trauma centers but doesn't identify how many patients received surgical care.  The ratio of delivery+surgical care to mortality should be identified.