301: MARCH Works - Wound Care and TBI are NEXT Layer

<p>Stacey Shackelford retired from the Air Force after serving as Joint Trauma System chief and trauma medical director in Colorado Springs. She now works at the Center for Combat Medicine at the University of Colorado. Dennis brings her on to walk through the 2021 case-control analysis of prehospital death and prolonged field care survival from U.S. combat operations between 2007 and 2015.</p><p>The study pulled patients with documented prehospital care lasting four to seventy-two hours and an AIS of two or greater. Roughly 3,200 casualties met the criteria out of a larger pool where only about 20% had any prehospital documentation. Average time from injury to evacuation was seven hours. Ninety percent of deaths occurred before the four-hour mark. The most common interventions among those with documentation were advanced airway (about a quarter), mechanical ventilation (about 18%), and tourniquets (about 9%). Blood transfusion in the first 24 hours occurred in roughly a quarter of the cohort; prehospital transfusion capability itself was still very limited during those years.</p><p>The conversation then turns to what still holds and what needs to move forward. MARCH remains the foundation. Wound care for contaminated injuries within about six hours and tourniquet conversion become higher priorities once patients survive the first hours. TBI is expected to stay common; the practical steps are a real GCS, head elevation, ETCO2 control, and limited hypertonic saline. Training is the remaining gap. Prolonged care is largely hospital care done in the field. </p><p>PFC Podcast · prolongedfieldcare.org · @prolonged_field_care</p><p><br></p><p><strong>Takeaways</strong></p><ol><li><strong>Most deaths still happen early.</strong> In the 2007–2015 cohort, 90% of deaths occurred before four hours. Average prehospital time among those who reached four to seventy-two hours was seven hours.</li><li><strong>Documentation was the bottleneck.</strong> Only about 20% of the larger trauma registry cohort had usable prehospital records. The study could only analyze the documented cases.</li><li><strong>The top interventions matched the basics.</strong> Advanced airway, mechanical ventilation, and tourniquets were the most common. Blood in the first 24 hours mattered, but prehospital transfusion capability was still rare during the study window.</li><li><strong>MARCH still applies; the next layer is wound care and TBI.</strong> Contaminated wounds need advanced care within ab